MEDICARE: PATE PSYCHOLOGICAL SERVICES PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	34160	TX

General Provider Information

NPI Number	:	1003123647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATE PSYCHOLOGICAL SERVICES PLLC

Provider Business Mailing Address
First Line	:	7505 SOUTH FWY
Second Line	:	STE F
City	:	HOUSTON
State	:	TX
Zip	:	77021-5928
Country	:	US
Telephone Number	:	713-741-8516
Fax Number	:	713-741-8517

Provider Business Practice Location Address
First Line	:	7505 SOUTH FWY
Second Line	:	STE F
City	:	HOUSTON
State	:	TX
Zip	:	77021-5928
Country	:	US
Telephone Number	:	713-741-8516
Fax Number	:	713-741-8517

Authorized Official
Title or Position	:	LICENSED CLINICAL PSYCHOLOGIST
Name	:	DR. TONNA D PATE
Credential	:	PSYD
Telephone Number	:	713-741-8516

Provider Enumeration Date	:	09/02/2010
Last Update Date	:	08/14/2012

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