Individual
COURTNEY TATUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1021 STONE CHAPEL WAY, FORT WORTH, TX 76179-7307
(682) 238-1016
Mailing address
1021 STONE CHAPEL WAY, FORT WORTH, TX 76179-7307
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
84740
TX
Other
Enumeration date
02/24/2022
Last updated
02/24/2022
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