Provider Demographics
NPI:1558406975
Name:BOYD-TATUM, KAREN (MASTER'S COUNSELOR)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:BOYD-TATUM
Suffix:
Gender:F
Credentials:MASTER'S COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 COMMERCIAL DR
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-5593
Mailing Address - Country:US
Mailing Address - Phone:864-459-9671
Mailing Address - Fax:
Practice Address - Street 1:101 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-5593
Practice Address - Country:US
Practice Address - Phone:864-459-9671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0421504Medicaid
SC3430Medicare ID - Type Unspecified