Provider Demographics
NPI:1114389871
Name:MARY K TATUM
Entity Type:Organization
Organization Name:MARY K TATUM
Other - Org Name:TRANQUIL SOUL COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:TATUM
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:561-908-4858
Mailing Address - Street 1:515 N FLAGLER DR
Mailing Address - Street 2:SUITE P-300
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-4321
Mailing Address - Country:US
Mailing Address - Phone:561-908-4858
Mailing Address - Fax:561-828-0589
Practice Address - Street 1:515 N FLAGLER DR
Practice Address - Street 2:SUITE P-300
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-4321
Practice Address - Country:US
Practice Address - Phone:561-908-4858
Practice Address - Fax:561-828-0589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty