Provider Demographics
NPI:1043340631
Name:TALBOT, PATRICK HERNAN (LMFT)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:HERNAN
Last Name:TALBOT
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 1:13252 ALTA VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-3463
Mailing Address - Country:US
Mailing Address - Phone:818-795-3598
Mailing Address - Fax:
Practice Address - Street 1:12450 VAN NUYS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-1392
Practice Address - Country:US
Practice Address - Phone:818-896-8366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42327106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist