| NPI | 1003136292 |
|---|---|
| Former Name | MARY TALLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 3758) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2019-08-07 |