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General NPI Number Information
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NPI Number | 1720946767
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Entity Type | Individual
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Provider Name | WING SUM TAM
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Gender | Female
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Dates
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Enumeration Date | 01/09/2026
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 5747 NANJACK CIR
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City | MEMPHIS
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State | TN
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Zip | 38115-2058
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Country | US
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Telephone | 901-401-1003
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Fax |
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Provider Business Mailing Address
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Address Line | 5747 NANJACK CIR
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City | MEMPHIS
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State | TN
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Zip | 38115-2058
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Country | US
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Telephone | 901-401-1003
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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 | 166012173
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License Number State | IL
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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 | 0717002574
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2910
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License Number State | TN
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