Provider Demographics
NPI:1003822719
Name:TATIS, JEAN SPENCE (MED, LMHC, NCC)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:SPENCE
Last Name:TATIS
Suffix:
Gender:F
Credentials:MED, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-3228
Mailing Address - Country:US
Mailing Address - Phone:508-421-4451
Mailing Address - Fax:508-795-1338
Practice Address - Street 1:45 SUMMER ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3228
Practice Address - Country:US
Practice Address - Phone:508-421-4451
Practice Address - Fax:508-795-1338
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA101YM0800XOtherMENTAL HEALTH COUNSELOR