Healthcare Provider Details

I. General information

NPI: 1295278828
Provider Name (Legal Business Name): QUINCY TATUM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CONCORD AVE
CHICO CA
95928-9487
US

IV. Provider business mailing address

55 TEHAMA ST
ORLAND CA
95963-1444
US

V. Phone/Fax

Practice location:
  • Phone: 530-879-5000
  • Fax:
Mailing address:
  • Phone: 530-332-0728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number150.117736
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: