Active NPI
Tanisha N Tatum, LEP
- Psychologist
- Los Angeles, CA
National Provider Identifier
1619504925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 3897
- Practice address
- 5777 W Century Blvd # 11102035
Los Angeles, CA 90045-5600 - Phone
- (424) 248-7355
- NPI assigned
- Mar 25, 2020
- Last updated
- Jun 13, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 3897 | CA | |
| Psychologist | 103T00000X | 3897 | CA | Primary |
| School Psychologist | 103TS0200X | 3897 | CA | |
| Rehabilitation Practitioner | 225400000X | CA | ||
| Behavior Analyst | 103K00000X | NU |
Addresses
Primary practice location
5777 W Century Blvd # 11102035
Los Angeles, CA 90045-5600
Mailing address
360 N Pacific Coast Hwy Ste 2000
El Segundo, CA 90245-4532
Phone (424) 248-7355
Other practice location 1
14903 S Normandie Ave Apt 117
Gardena, CA 90247-2964
Phone (424) 248-7355
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
| License | State | Type | Specialty |
|---|---|---|---|
| 3897 | CA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686614400000",
"number": "1619504925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "360 N PACIFIC COAST HWY STE 2000",
"city": "EL SEGUNDO",
"state": "CA",
"postal_code": "902454532",
"telephone_number": "424-248-7355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5777 W CENTURY BLVD # 11102035",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900455600",
"telephone_number": "424-248-7355"
}
],
"practiceLocations": [
{
"address_1": "14903 S Normandie Ave Apt 117",
"address_purpose": "LOCATION",
"city": "Gardena",
"state": "CA",
"postal_code": "902472964",
"country_code": "US",
"telephone_number": "424-248-7355",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TATUM",
"first_name": "TANISHA",
"middle_name": "N",
"credential": "LEP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-03-25",
"last_updated": "2023-06-13",
"certification_date": "2023-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "CA",
"license": "3897",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "3897",
"primary": true
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "CA",
"license": "3897",
"primary": false
},
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.