Provider Demographics
NPI:1497008395
Name:TATEM, BEATRICE ANTLY (PHD)
Entity type:Individual
Prefix:DR
First Name:BEATRICE
Middle Name:ANTLY
Last Name:TATEM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N 18TH ST
Mailing Address - Street 2:SUITE 414
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-4432
Mailing Address - Country:US
Mailing Address - Phone:318-410-1555
Mailing Address - Fax:
Practice Address - Street 1:1900 N 18TH ST
Practice Address - Street 2:SUITE 414
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-4432
Practice Address - Country:US
Practice Address - Phone:318-410-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1736101Y00000X, 101YM0800X, 101YP2500X, 102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst