Provider Demographics
NPI:1992178669
Name:TATUM, CYNTHIA (LMFT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:TATUM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13100 STONEFIELD DR APT 1105
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-3304
Mailing Address - Country:US
Mailing Address - Phone:832-997-1655
Mailing Address - Fax:
Practice Address - Street 1:13100 STONEFIELD DR APT 1105
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-3304
Practice Address - Country:US
Practice Address - Phone:832-997-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF81876106H00000X
106S00000X
CA11589106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician