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Individual
MS. DIANE W. TATEM
Active
Individual
MS. DIANE W. TATEM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.C.
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5647
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2474LC
BCBS PROVIDER NO.
TX
01
—
35503
MAGELLAN PROVDER NO.
TX
Enumeration date
08/05/2006
Last updated
07/09/2007
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