Healthcare Provider Details

I. General information

NPI: 1881029957
Provider Name (Legal Business Name): MS. ROBYN MICHELE TATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 S COMMERCE DR STE 250
MURRAY UT
84107-7926
US

IV. Provider business mailing address

672 W 400 S STE 201
SPRINGVILLE UT
84663-3170
US

V. Phone/Fax

Practice location:
  • Phone: 801-261-3500
  • Fax:
Mailing address:
  • Phone: 801-369-8989
  • Fax: 801-704-9741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9039380-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number261QM0801X
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: