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General NPI Number Information
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NPI Number | 1801686167
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Entity Type | Organization
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Legal Business Name | TATUM D. TEEPLE, MS, TLLP, PLLC
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Dates
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Enumeration Date | 05/09/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 534 FOUNTAIN ST NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-3422
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Country | US
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Telephone | 616-456-1178
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Fax |
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Provider Business Mailing Address
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Address Line | 4374 VALLA CT SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-2452
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Country | US
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Telephone | 567-525-0059
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | TATUM DAYE TEEPLE
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Credential | MS, MLP
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Telephone | 567-525-0050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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