NPIMap

Individual provider Active NPI

Matthew Thomas Tatum, PSYD

  • Clinical Psychologist
  • Clovis, CA
National Provider Identifier
1366672313
Registry record updated Aug 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY25350 Issued in CA
Practice address
2343 Deauville Cir
Clovis, CA 93619-4292
Phone
(559) 797-4460
NPI assigned
Jul 23, 2009
Last updated
Aug 4, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 4, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY25350 CA Primary

Addresses

Primary practice location

2343 Deauville Cir
Clovis, CA 93619-4292

Mailing address

7065 N Maple Ave
Fresno, CA 93720-8013
Phone (559) 326-7775

Other practice location 1

7065 N Maple Ave
Fresno, CA 93720-8013
Phone (559) 326-7775

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSY25350CAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Sierra Meadows and Ascend Psychiatric Group Inc. Current Accepting new patients
Oasis Eating Disorder Recovery a Professional Psychology Corporation Current Accepting new patients
Ascend Psychiatric Group Inc Current Accepting new patients

Organizations & group practices 13

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1248307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596499200000",
    "number": "1366672313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7065 N MAPLE AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937208013",
            "telephone_number": "559-326-7775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2343 DEAUVILLE CIR",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936194292",
            "telephone_number": "559-797-4460"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7065 N Maple Ave",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937208013",
            "country_code": "US",
            "telephone_number": "559-326-7775",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TATUM",
        "first_name": "MATTHEW",
        "middle_name": "THOMAS",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-07-23",
        "last_updated": "2020-08-04",
        "certification_date": "2020-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY25350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clovis, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.