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General NPI Number Information
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NPI Number | 1558873877
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Entity Type | Individual
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Provider Name | LASHIVER PATE
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Gender | Male
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Dates
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Enumeration Date | 10/26/2017
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Last Update Date | 10/26/2017
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Provider Practice Location Address
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Address Line | 2601 LINCOLN HWY
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461-1862
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Country | US
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Telephone | 773-236-0966
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Fax |
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Provider Business Mailing Address
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Address Line | 22728 MILLARD AVE
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City | RICHTON PARK
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State | IL
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Zip | 60471-2529
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Country | US
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Telephone |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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