Basic Information
| Provider Information | |||||||||
| NPI: | 1174262935 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TALLON | ||||||||
| FirstName: | DARBY | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | LLMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5971 WEISS ST APT O2 | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486032716 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 301 S CRAPO ST # 100 | ||||||||
| Address2: | |||||||||
| City: | MT PLEASANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488582941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897725938 | ||||||||
| FaxNumber: | 9897757701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2022 | ||||||||
| LastUpdateDate: | 05/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6851114689 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.