Organization
RADICAL AUTHENTICITY & WELLNESS PSYCHOTHERAPY GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDER K TATUM PHD (PRESIDENT)
(434) 284-3806
Entity
Organization
Contact information
Practice address
1554 W HOLLYWOOD AVE, CHICAGO, IL 60660-4399
(434) 284-3806
Mailing address
5754 N WINTHROP AVE APT 3, CHICAGO, IL 60660-5148
(434) 284-3806
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
103TC0700X
Clinical Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
Other
Enumeration date
01/23/2023
Last updated
01/23/2023
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