Talmage W Delange, M.ED, LCPC
Individual provider Active NPI Professional Counselor · Mountain Home, ID
NPI 1124113709 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1124113709
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- LCPC 382 (ID)
- Practice address
- 235 North 3Rd East
Mountain Home, ID 83647 - Phone
- (208) 724-8120
- Fax
- (208) 587-2992
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCPC 382 | ID | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sufficiency Advocate, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LCPC 382 | ID | Yes |
Addresses
Primary practice location
235 North 3Rd East
Mountain Home, ID 83647
Mailing address
115 Dewey Street
Mountain Home, ID 83647
Phone (208) 724-8120
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q5944 | Other | ID | BLUE CROSS BLUE SHIELD |
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All providers in Mountain Home, ID · Professional Counselor in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.