Provider Demographics
NPI:1952631889
Name:TATUM, TIMOTHY J (MA, LPC-MHSP, NCC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:TATUM
Suffix:
Gender:M
Credentials:MA, LPC-MHSP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 BRENTLY WOODS DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2650 EXECUTIVE PARK NW
Practice Address - Street 2:SUITE 3
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-2746
Practice Address - Country:US
Practice Address - Phone:423-473-2633
Practice Address - Fax:423-473-2643
Is Sole Proprietor?:No
Enumeration Date:2009-12-26
Last Update Date:2009-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000002349101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor