Provider Demographics
NPI:1437701224
Name:TALLEY, JILLIAN (PHD)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:
Last Name:TALLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CAMPUS CTR RM 110
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-8000
Mailing Address - Country:US
Mailing Address - Phone:831-582-3622
Mailing Address - Fax:
Practice Address - Street 1:100 CAMPUS CTR RM 110
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-8000
Practice Address - Country:US
Practice Address - Phone:831-582-3622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2025-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY35505103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist