MEDICARE: COURTNEY TATE LPC

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	101YM0800X	Mental Health Counselor	18725	TX
2	101YP2500X	Professional Counselor	18725	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770643306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY TATE LPC

Provider Business Mailing Address
First Line	:	PO BOX 1108
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76503-1108
Country	:	US
Telephone Number	:	254-773-4022
Fax Number	:	254-773-0919

Provider Business Practice Location Address
First Line	:	3010 SCOTT BLVD STE 103
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76504-6803
Country	:	US
Telephone Number	:	254-773-4022
Fax Number	:	254-773-0919

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	12/10/2024

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Directions to “ COURTNEY TATE LPC” Practice Location

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