Provider Demographics
NPI:1780165290
Name:TATIS, ABRAHAM (MA, LMHC)
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:
Last Name:TATIS
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 10TH AVE N STE 601
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-6618
Mailing Address - Country:US
Mailing Address - Phone:561-823-3178
Mailing Address - Fax:561-516-8861
Practice Address - Street 1:2290 10TH AVE N STE 601
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-6618
Practice Address - Country:US
Practice Address - Phone:561-823-3178
Practice Address - Fax:561-516-8861
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19656101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health