Provider Demographics
NPI:1760963987
Name:TALTON, ALONZO II (LADC/MH)
Entity type:Individual
Prefix:MR
First Name:ALONZO
Middle Name:
Last Name:TALTON
Suffix:II
Gender:
Credentials:LADC/MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2919 EMBASSY ROW
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-2209
Mailing Address - Country:US
Mailing Address - Phone:925-303-5807
Mailing Address - Fax:
Practice Address - Street 1:15 W 6TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-5415
Practice Address - Country:US
Practice Address - Phone:918-295-5055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-25
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1481101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)