Provider Demographics
NPI:1699103812
Name:TALLON, JAIME S SR (MH, PSYD, CMHP, CAP)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:S
Last Name:TALLON
Suffix:SR
Gender:M
Credentials:MH, PSYD, CMHP, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7490 SW 23RD ST
Mailing Address - Street 2:SUITE NO, 201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1419
Mailing Address - Country:US
Mailing Address - Phone:786-953-8221
Mailing Address - Fax:305-485-3048
Practice Address - Street 1:7490 SW 23RD ST
Practice Address - Street 2:SUITE NO, 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1419
Practice Address - Country:US
Practice Address - Phone:786-953-8221
Practice Address - Fax:305-485-3048
Is Sole Proprietor?:No
Enumeration Date:2013-10-25
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7243101YM0800X
FL50541101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional