Provider Demographics
NPI:1417311424
Name:TALLEY, ANTHONY M SR (LMHC)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:M
Last Name:TALLEY
Suffix:SR
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8760 POWDERHORN WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1178
Mailing Address - Country:US
Mailing Address - Phone:317-590-4572
Mailing Address - Fax:866-598-3720
Practice Address - Street 1:8760 POWDERHORN WAY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1178
Practice Address - Country:US
Practice Address - Phone:317-590-4572
Practice Address - Fax:866-598-3720
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87001582A101YA0400X
IN39002852A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)