Individual
RAY TALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
6952
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1381005654
TRICARE
SD
Enumeration date
08/16/2016
Last updated
12/17/2025
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