Provider Demographics
NPI:1043910565
Name:TATUM, JESSICA DENISE (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DENISE
Last Name:TATUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 NARROW RD
Mailing Address - Street 2:
Mailing Address - City:MENDENHALL
Mailing Address - State:MS
Mailing Address - Zip Code:39114-5432
Mailing Address - Country:US
Mailing Address - Phone:601-316-8046
Mailing Address - Fax:
Practice Address - Street 1:118 NARROW RD
Practice Address - Street 2:
Practice Address - City:MENDENHALL
Practice Address - State:MS
Practice Address - Zip Code:39114-5432
Practice Address - Country:US
Practice Address - Phone:601-316-8046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC105031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical