Provider Demographics
NPI:1871348656
Name:TALAMANTE, ARYN AMETHYST
Entity type:Individual
Prefix:
First Name:ARYN
Middle Name:AMETHYST
Last Name:TALAMANTE
Suffix:
Gender:F
Credentials:
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 531
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:NM
Mailing Address - Zip Code:87416-0531
Mailing Address - Country:US
Mailing Address - Phone:505-592-7006
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1199
Practice Address - Street 2:
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420-1199
Practice Address - Country:US
Practice Address - Phone:505-368-4984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2023-06201041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool