Individual
ALEXANDER KYLE TATUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5412 N CLARK ST STE 212, CHICAGO, IL 60640-1273
(773) 257-3606
Mailing address
5412 N CLARK ST STE 212, CHICAGO, IL 60640-1273
(434) 284-3806
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.010516
IL
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/24/2018
Last updated
02/02/2026
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