Basic Information
| Provider Information | |||||||||
| NPI: | 1043340631 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TALBOT | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | HERNAN | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13252 ALTA VISTA WAY | ||||||||
| Address2: | |||||||||
| City: | SYLMAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913423463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187953598 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12450 VAN NUYS BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | PACOIMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913311392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188968366 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC 42327 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.