Provider Demographics
NPI:1225423163
Name:TATUM, MARY (LMHC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TATUM
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:561-376-7271
Mailing Address - Fax:
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:561-376-7271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)