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General NPI Number Information
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NPI Number | 1720503964
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Entity Type | Individual
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Provider Name | GABRIELLE ANE TATE
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Gender | Female
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Dates
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Enumeration Date | 08/09/2017
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Last Update Date | 08/09/2017
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Provider Practice Location Address
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Address Line | 650 S PEORIA AVE
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City | TULSA
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State | OK
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Zip | 74120-4429
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Country | US
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Telephone | 918-587-9471
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Fax | 918-560-1399
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Provider Business Mailing Address
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Address Line | 2800 N 23RD ST APT 2016
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City | BROKEN ARROW
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State | OK
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Zip | 74014-2044
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6117-P
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License Number State | OK
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