Provider Demographics
NPI:1548354343
Name:TALKINGTON, ALISA SIMON (PSYD)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:SIMON
Last Name:TALKINGTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 830323
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34483-0323
Mailing Address - Country:US
Mailing Address - Phone:352-615-8884
Mailing Address - Fax:321-247-6970
Practice Address - Street 1:217 SE 1ST AVE STE 200
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-2161
Practice Address - Country:US
Practice Address - Phone:352-615-8884
Practice Address - Fax:321-247-6970
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7391103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAB159ZMedicare PIN