MEDICARE: DWAYNE REMON TATE

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	101Y00000X	Counselor
2	175T00000X	Peer Specialist		OK

General Provider Information

NPI Number	:	1124454277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DWAYNE REMON TATE

Provider Business Mailing Address
First Line	:	10217 E 21ST PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74129-4602
Country	:	US
Telephone Number	:	305-762-2083
Fax Number	:

Provider Business Practice Location Address
First Line	:	8906 E SKELLY DR STE J
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74129-3406
Country	:	US
Telephone Number	:	305-762-2083
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2013
Last Update Date	:	04/23/2026

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Directions to “ DWAYNE REMON TATE ” Practice Location

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