Provider Demographics
NPI:1548912298
Name:TATUM, TAMARA ESTHER (MA LMFT, IMFT)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:ESTHER
Last Name:TATUM
Suffix:
Gender:F
Credentials:MA LMFT, IMFT
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:ESTHER
Other - Last Name:GULASEKHARAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7265 KENWOOD RD STE 321
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-4416
Mailing Address - Country:US
Mailing Address - Phone:513-657-9337
Mailing Address - Fax:
Practice Address - Street 1:7265 KENWOOD RD STE 321
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-4416
Practice Address - Country:US
Practice Address - Phone:513-657-9337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202838101YM0800X
OHF.2100227101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHF.2100227OtherSTATE OF OHIO COUNSELOR, SOCIAL WORKER, & MARRIAGE AND FAMILY THERAPIST BOARD
TX202838OtherTEXAS STATE BOARD OF EXAMINERS OF MARRIAGE AND FAMILY THERAPISTS