Provider Demographics
NPI:1962578302
Name:TALLEY, JIM ALLEN (LMFT)
Entity type:Individual
Prefix:DR
First Name:JIM
Middle Name:ALLEN
Last Name:TALLEY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11805 SYLVESTER DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-1018
Mailing Address - Country:US
Mailing Address - Phone:405-720-8300
Mailing Address - Fax:
Practice Address - Street 1:11805 SYLVESTER DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-1018
Practice Address - Country:US
Practice Address - Phone:405-720-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK505106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist