Provider Demographics
NPI:1134652787
Name:TATUM, THAD
Entity Type:Individual
Prefix:
First Name:THAD
Middle Name:
Last Name:TATUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3251 BELFORT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-2817
Mailing Address - Country:US
Mailing Address - Phone:504-427-1713
Mailing Address - Fax:504-827-2715
Practice Address - Street 1:3330 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6206
Practice Address - Country:US
Practice Address - Phone:504-827-2701
Practice Address - Fax:504-827-2715
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health