Provider Demographics
NPI:1700066222
Name:TATUM-SHIPLEY, CINDY LOU (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CINDY
Middle Name:LOU
Last Name:TATUM-SHIPLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8657 W ROWEL RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-3708
Mailing Address - Country:US
Mailing Address - Phone:623-876-2029
Mailing Address - Fax:623-933-7729
Practice Address - Street 1:8657 W ROWEL RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-3708
Practice Address - Country:US
Practice Address - Phone:623-876-2029
Practice Address - Fax:623-933-7729
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-24011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical