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General NPI Number Information
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NPI Number | 1013229533
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Entity Type | Individual
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Provider Name | MISS MICHELLE L TATE
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Gender | Female
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Dates
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Enumeration Date | 07/13/2010
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Last Update Date | 07/13/2010
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Provider Practice Location Address
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Address Line | 118 E COURT ST
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City | PARIS
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State | IL
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Zip | 61944-2210
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Country | US
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Telephone | 217-465-4118
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1118
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City | PARIS
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State | IL
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Zip | 61944-5118
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Country | US
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Telephone | 217-465-4118
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178006408
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License Number State | IL
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