Provider Demographics
NPI:1194262907
Name:TALLEY, ANNA MICHELLE (LCSW-BACS)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:MICHELLE
Last Name:TALLEY
Suffix:
Gender:F
Credentials:LCSW-BACS
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:MICHELLE
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:510 E STONER AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101
Mailing Address - Country:US
Mailing Address - Phone:318-221-8411
Mailing Address - Fax:318-990-5545
Practice Address - Street 1:510 E STONER AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101
Practice Address - Country:US
Practice Address - Phone:318-221-8411
Practice Address - Fax:318-990-5545
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA85911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical