Provider Demographics
NPI:1972747368
Name:TATUM, SHANNON LEE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:LEE
Last Name:TATUM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 W SUMMIT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-3194
Mailing Address - Country:US
Mailing Address - Phone:734-276-8563
Mailing Address - Fax:
Practice Address - Street 1:122 S MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1929
Practice Address - Country:US
Practice Address - Phone:734-707-7411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010889041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical