Provider Demographics
NPI:1275729212
Name:TATUM, MELBA ROSE (LCSW, LCDC)
Entity Type:Individual
Prefix:MRS
First Name:MELBA
Middle Name:ROSE
Last Name:TATUM
Suffix:
Gender:F
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:MELBA
Other - Middle Name:ROSE
Other - Last Name:TATUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, LCDC
Mailing Address - Street 1:150 WEST SHADOWBEND AVE. SUITE 100
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546
Mailing Address - Country:US
Mailing Address - Phone:832-577-8901
Mailing Address - Fax:281-332-0057
Practice Address - Street 1:1002 E STADIUM DR
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-2579
Practice Address - Country:US
Practice Address - Phone:281-762-8383
Practice Address - Fax:281-762-8355
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2022-10-31
Deactivation Date:2022-10-25
Deactivation Code:
Reactivation Date:2022-10-31
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
TX136941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical