Healthcare Provider Details

I. General information

NPI: 1124932579
Provider Name (Legal Business Name): NATHAN L TATE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1111 MAGNOLIA CT STE 205
MOORE OK
73160-1391
US

IV. Provider business mailing address

1111 MAGNOLIA CT STE 205
MOORE OK
73160-1391
US

V. Phone/Fax

Practice location:
  • Phone: 405-544-4357
  • Fax:
Mailing address:
  • Phone: 405-544-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: