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General NPI Number Information
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NPI Number | 1619358587
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Entity Type | Organization
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Legal Business Name | G TATE AND ASSOCIATES,LLC
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Dates
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Enumeration Date | 06/16/2015
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Last Update Date | 06/16/2015
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Provider Practice Location Address
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Address Line | 423 BOWMAN ST
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City | MANSFIELD
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State | OH
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Zip | 44903-1201
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Country | US
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Telephone | 419-512-5487
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Fax |
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Provider Business Mailing Address
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Address Line | 423 BOWMAN ST
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City | MANSFIELD
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State | OH
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Zip | 44903-1201
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Country | US
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Telephone | 419-512-5487
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. GERON L. TATE
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Credential | LICDC-CS
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Telephone | 414-512-5487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 965660
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License Number State | OH
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