Provider Demographics
NPI:1538220637
Name:TALLEY, ARIK (LMSW)
Entity type:Individual
Prefix:
First Name:ARIK
Middle Name:
Last Name:TALLEY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24660 RIDGEDALE ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1452
Mailing Address - Country:US
Mailing Address - Phone:313-221-4994
Mailing Address - Fax:
Practice Address - Street 1:24660 RIDGEDALE ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1452
Practice Address - Country:US
Practice Address - Phone:313-221-4994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010864771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical