MEDICARE: WING SUM TAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	166012173	IL
2	106H00000X	Marriage & Family Therapist	MFT002362	GA
3	106H00000X	Marriage & Family Therapist	0717002574	VA
4	106H00000X	Marriage & Family Therapist	2910	TN

General Provider Information

NPI Number	:	1720946767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WING SUM TAM

Provider Business Mailing Address
First Line	:	5747 NANJACK CIR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38115-2058
Country	:	US
Telephone Number	:	901-401-1003
Fax Number	:

Provider Business Practice Location Address
First Line	:	5747 NANJACK CIR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38115-2058
Country	:	US
Telephone Number	:	901-401-1003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	05/15/2026

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Directions to “ WING SUM TAM ” Practice Location

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