Provider Demographics
NPI:1447595244
Name:SIRCH, TATUM E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TATUM
Middle Name:E
Last Name:SIRCH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 BIRCH ALY STE 240
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45440-1477
Mailing Address - Country:US
Mailing Address - Phone:937-765-1507
Mailing Address - Fax:
Practice Address - Street 1:70 BIRCH ALY STE 240
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440
Practice Address - Country:US
Practice Address - Phone:937-765-1507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103T00000X
OHP.07713103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist