Provider Demographics
NPI:1730943341
Name:AVEN, TATUM I
Entity type:Individual
Prefix:MRS
First Name:TATUM
Middle Name:I
Last Name:AVEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-4831
Mailing Address - Country:US
Mailing Address - Phone:858-888-5614
Mailing Address - Fax:866-608-5560
Practice Address - Street 1:2300 ASPEN DR
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-4831
Practice Address - Country:US
Practice Address - Phone:858-888-5614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician