Provider Demographics
NPI:1487276911
Name:TATUM, JESSE LEE (LMFT, LPCC)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:LEE
Last Name:TATUM
Suffix:
Gender:M
Credentials:LMFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 TORO ST STE C
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3356
Mailing Address - Country:US
Mailing Address - Phone:805-550-4380
Mailing Address - Fax:
Practice Address - Street 1:1171 TORO ST STE C
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3356
Practice Address - Country:US
Practice Address - Phone:805-550-4380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT152548106H00000X
CALPCC19466101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional