Provider Demographics
NPI:1982801262
Name:TATUM, JACQUELYN FRANKLIN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:FRANKLIN
Last Name:TATUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 COUNTY ROAD 90
Mailing Address - Street 2:SUITE 119
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4890
Mailing Address - Country:US
Mailing Address - Phone:281-485-9280
Mailing Address - Fax:281-485-9070
Practice Address - Street 1:2225 COUNTY ROAD 90
Practice Address - Street 2:SUITE 119
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-4890
Practice Address - Country:US
Practice Address - Phone:281-485-9280
Practice Address - Fax:281-485-9070
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX386871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical