Healthcare Provider Details

I. General information

NPI: 1730518606
Provider Name (Legal Business Name): KEENA TATE LCPC, LMHC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 E FLAMINGO RD STE 100
LAS VEGAS NV
89119-5280
US

IV. Provider business mailing address

125 E REGENA AVE UNIT 235
NORTH LAS VEGAS NV
89031-3665
US

V. Phone/Fax

Practice location:
  • Phone: 702-498-3377
  • Fax:
Mailing address:
  • Phone: 702-352-6008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC017190
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCP5544
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61553975
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: