Provider Demographics
NPI:1992216956
Name:TATUM, KATRINA YVONNE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:YVONNE
Last Name:TATUM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8528 DAVIS BLVD # 134
Mailing Address - Street 2:#154
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-8367
Mailing Address - Country:US
Mailing Address - Phone:817-601-5266
Mailing Address - Fax:
Practice Address - Street 1:6100 BROWNING DR APT 2206
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-6090
Practice Address - Country:US
Practice Address - Phone:903-314-0645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73474101YM0800X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor