Provider Demographics
NPI:1861962094
Name:TALLEY, REID (CADCDP)
Entity type:Individual
Prefix:
First Name:REID
Middle Name:
Last Name:TALLEY
Suffix:
Gender:M
Credentials:CADCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12010 ELMHURST
Mailing Address - Street 2:19451 MENDOTA
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-4820
Mailing Address - Country:US
Mailing Address - Phone:313-867-1090
Mailing Address - Fax:313-867-0706
Practice Address - Street 1:12010 ELMHURST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206
Practice Address - Country:US
Practice Address - Phone:313-867-1090
Practice Address - Fax:313-867-0706
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI175T00000X
MI6803086847101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist