Provider Demographics
NPI:1528084993
Name:WAHL TALLEY, JUDY (MA, LMFT)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:WAHL TALLEY
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E SAN MARCOS BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-2988
Mailing Address - Country:US
Mailing Address - Phone:760-731-6250
Mailing Address - Fax:866-561-3747
Practice Address - Street 1:100 E SAN MARCOS BLVD STE 400
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2988
Practice Address - Country:US
Practice Address - Phone:760-731-6250
Practice Address - Fax:866-561-3747
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1026106H00000X
CALMFT109568106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist