Healthcare Provider Details

I. General information

NPI: 1851263784
Provider Name (Legal Business Name): LASHUNDRA REENISE TATE ALC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 164
SHORTER AL
36075-0164
US

IV. Provider business mailing address

PO BOX 164
SHORTER AL
36075-0164
US

V. Phone/Fax

Practice location:
  • Phone: 316-397-0746
  • Fax:
Mailing address:
  • Phone: 316-397-0746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberALC04520
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: