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General NPI Number Information
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NPI Number | 1871187500
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Entity Type | Individual
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Provider Name | ANGEL NICOLE TATUM LSW
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Gender | Female
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Dates
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Enumeration Date | 02/23/2021
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Last Update Date | 02/23/2021
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Provider Practice Location Address
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Address Line | 500 N MICHIGAN AVE STE 1530
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City | CHICAGO
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State | IL
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Zip | 60611-3758
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Country | US
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Telephone | 630-428-7890
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Fax |
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Provider Business Mailing Address
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Address Line | 8141 S MARSHFIELD AVE APT 3
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City | CHICAGO
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State | IL
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Zip | 60620-5791
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Country | US
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Telephone | 912-580-9885
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150.104413
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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