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General NPI Number Information
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NPI Number | 1952631889
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Entity Type | Individual
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Provider Name | TIMOTHY J TATUM MA, LPC-MHSP, NCC
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Gender | Male
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Dates
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Enumeration Date | 12/26/2009
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Last Update Date | 12/26/2009
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Provider Practice Location Address
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Address Line | 2650 EXECUTIVE PARK NW SUITE 3
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City | CLEVELAND
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State | TN
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Zip | 37312-2746
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Country | US
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Telephone | 423-473-2633
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Fax | 423-473-2643
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Provider Business Mailing Address
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Address Line | 126 BRENTLY WOODS DR
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City | CHATTANOOGA
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State | TN
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Zip | 37421-4449
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Country | US
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Telephone |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC0000002349
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License Number State | TN
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