Healthcare Provider Details

I. General information

NPI: 1497008395
Provider Name (Legal Business Name): BEATRICE ANTLY TATEM PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N 18TH ST SUITE 414
MONROE LA
71201-4432
US

IV. Provider business mailing address

1900 N 18TH ST SUITE 414
MONROE LA
71201-4432
US

V. Phone/Fax

Practice location:
  • Phone: 318-410-1555
  • Fax:
Mailing address:
  • Phone: 318-410-1555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1736
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1736
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1736
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number1736
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: