Jerron Depaul Tatum

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

133341 Issued in CA

Practice address

990 Villa Street, Moutain View, Ca
Los Angeles, CA 90043

Phone

(888) 688-9296

NPI assigned

Nov 1, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Marriage and Family Therapist

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pacific Blue Psychological ServicesGroup PAC ID 3678908357, 23 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

• Pacific Blue Psychological Services

  • Psychologist
  • Sherman Oaks, CA
  • NPI 1124678719
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1635724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736467200000",
    "number": "1982369468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 W REGENT ST APT 305",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903011044",
            "telephone_number": "323-703-3278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 VILLA STREET, MOUTAIN VIEW, CA",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90043",
            "telephone_number": "888-688-9296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATUM",
        "first_name": "JERRON",
        "middle_name": "DEPAUL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-11-01",
        "last_updated": "2025-01-10",
        "certification_date": "2025-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "133341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Tatro, AUD
• Christina Yen Tatsuyama, D.P.T
• Amber Tatum
• Christopher Tatum
• Christopher Tatum, PAC
• Kevin Tatum
• Richard Tatum
• Tanisha N Tatum, LEP
• J Lucy Tauber
• Abigail Celia Taubman

• Marriage & Family Therapist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.