Provider Demographics
NPI:1154096493
Name:MONTOYA, TATUM MARIE
Entity type:Individual
Prefix:
First Name:TATUM
Middle Name:MARIE
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TATUM
Other - Middle Name:M
Other - Last Name:ROBERGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:272 PALMER ROAD
Mailing Address - Street 2:
Mailing Address - City:GATLINBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37738-4115
Mailing Address - Country:US
Mailing Address - Phone:774-644-6702
Mailing Address - Fax:
Practice Address - Street 1:272 PALMER ROAD
Practice Address - Street 2:
Practice Address - City:GATLINBURG
Practice Address - State:TN
Practice Address - Zip Code:37738-4115
Practice Address - Country:US
Practice Address - Phone:774-644-6702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MALMHC10000121101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health