Provider Demographics
NPI:1023385366
Name:TATE, PHILLIP S (PHD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:S
Last Name:TATE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2920
Mailing Address - Country:US
Mailing Address - Phone:253-383-3355
Mailing Address - Fax:253-383-3627
Practice Address - Street 1:2013 S 19TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2920
Practice Address - Country:US
Practice Address - Phone:253-383-3355
Practice Address - Fax:253-383-3627
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60232335103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist