Provider Demographics
NPI:1881438414
Name:MARTIN, TATUM JAYME
Entity type:Individual
Prefix:
First Name:TATUM
Middle Name:JAYME
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-3142
Mailing Address - Country:US
Mailing Address - Phone:805-901-7121
Mailing Address - Fax:
Practice Address - Street 1:260 MAPLE CT STE 228
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3568
Practice Address - Country:US
Practice Address - Phone:805-791-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA146617106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist