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General NPI Number Information
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NPI Number | 1508368838
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Entity Type | Organization
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Legal Business Name | EMILY TATE LLC
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Dates
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Enumeration Date | 03/02/2018
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Last Update Date | 05/01/2019
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Provider Practice Location Address
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Address Line | 1601 HEALTH CENTER PARKWAY BUILDING 600 SUITE 5
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City | YUKON
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State | OK
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Zip | 73099-7732
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Country | US
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Telephone | 405-249-1411
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Fax |
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Provider Business Mailing Address
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Address Line | 9009 NW 92ND ST
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City | YUKON
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State | OK
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Zip | 73099-8424
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Country | US
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Telephone | 405-249-1411
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Fax | 888-499-3569
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Authorized Official
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Title or Position | OWNER
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Name | EMILY TATE
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Credential | LPC
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Telephone | 405-249-1411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6737
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License Number State | OK
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