Provider Demographics
NPI:1578853735
Name:CINDY L. TATUM, CMSW, INC.
Entity Type:Organization
Organization Name:CINDY L. TATUM, CMSW, INC.
Other - Org Name:CLTATUM & ASSOCIATES COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:TATUM-SHIPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:623-876-2029
Mailing Address - Street 1:PO BOX 5160
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85385-5160
Mailing Address - Country:US
Mailing Address - Phone:623-876-2029
Mailing Address - Fax:623-933-7729
Practice Address - Street 1:5400 W NORTHERN AVE
Practice Address - Street 2:BUILDING B, SUITE 108 AND 108A
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-1406
Practice Address - Country:US
Practice Address - Phone:602-574-0826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-3564101YA0400X
AZBH-3654101YM0800X, 101YP2500X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty