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General NPI Number Information
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NPI Number | 1043910565
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Entity Type | Individual
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Provider Name | JESSICA DENISE TATUM LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/03/2023
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 665 S PEAR ORCHARD RD
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City | RIDGELAND
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State | MS
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Zip | 39157-4861
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Country | US
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Telephone | 601-345-1906
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 884
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City | MAGEE
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State | MS
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Zip | 39111-0884
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Country | US
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Telephone | 601-316-8046
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C10503
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License Number State | MS
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