Healthcare Provider Details

I. General information

NPI: 1154096493
Provider Name (Legal Business Name): TATUM MARIE MONTOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TATUM M ROBERGE

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 11/12/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 PALMER ROAD
GATLINBURG TN
37738-4115
US

IV. Provider business mailing address

272 PALMER ROAD
GATLINBURG TN
37738-4115
US

V. Phone/Fax

Practice location:
  • Phone: 774-644-6702
  • Fax:
Mailing address:
  • Phone: 774-644-6702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10000121
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: