1548912298 NPI number — TAMARA ESTHER TATUM M.A. LMFT, IMFT

Table of content: TAMARA ESTHER TATUM M.A. LMFT, IMFT (NPI 1548912298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548912298 NPI number — TAMARA ESTHER TATUM M.A. LMFT, IMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TATUM
Provider First Name:
TAMARA
Provider Middle Name:
ESTHER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A. LMFT, IMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GULASEKHARAM
Provider Other First Name:
TAMARA
Provider Other Middle Name:
ESTHER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548912298
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7265 KENWOOD RD STE 321
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45236-4416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-657-9337
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7265 KENWOOD RD STE 321
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45236-4416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-657-9337
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/24/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  202838 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: F.2100227 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F.2100227 . This is a "STATE OF OHIO COUNSELOR, SOCIAL WORKER, & MARRIAGE AND FAMILY THERAPIST BOARD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 202838 . This is a "TEXAS STATE BOARD OF EXAMINERS OF MARRIAGE AND FAMILY THERAPISTS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".