Healthcare Provider Details

I. General information

NPI: 1285159830
Provider Name (Legal Business Name): LEIGH SCOTTEN TATUM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2146 FRAYSER BLVD
MEMPHIS TN
38127-5755
US

IV. Provider business mailing address

6350 W ANDREW JOHNSON HWY DEPT 100
TALBOTT TN
37877-8605
US

V. Phone/Fax

Practice location:
  • Phone: 901-302-4361
  • Fax: 865-342-0121
Mailing address:
  • Phone: 800-355-3565
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11814
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW7842
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: