Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
Y | 103G00000X | Clinical Psychologist | 37906 | TX |
Y | 103TC0700X | Clinical Psychologist | 37906 | TX |
N | 103TF0200X | Forensic Psychologist | ||
N | 103TP2701X | Group Psychotherapist |
NPI | 1013401371 |
---|---|
Provider Name | Leana Sue Baggett Talbott |
First Address | San Angelo, TX 76903-6310 |
Second Address | San Angelo, TX 76903-6310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2018 |
Last Update Date | 20/06/2018 |