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General NPI Number Information
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NPI Number | 1659820744
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Entity Type | Individual
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Provider Name | TATUM MARCUS
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Gender | Female
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Dates
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Enumeration Date | 09/29/2016
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 4314 N MISSISSIPPI AVE
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City | PORTLAND
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State | OR
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Zip | 97217-3135
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Country | US
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Telephone | 503-891-9700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 83261
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City | PORTLAND
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State | OR
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Zip | 97283-0261
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Country | US
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Telephone | 503-891-9700
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT-881
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 144188
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC177186
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | T2394
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License Number State | OR
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