Provider Demographics
NPI:1114350022
Name:TONNA D. PATE, PSYD
Entity Type:Organization
Organization Name:TONNA D. PATE, PSYD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TONNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PATE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:575-808-8018
Mailing Address - Street 1:1096 MECHEM DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-7067
Mailing Address - Country:US
Mailing Address - Phone:575-808-8018
Mailing Address - Fax:
Practice Address - Street 1:1096 MECHEM DR
Practice Address - Street 2:SUITE 208
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-7067
Practice Address - Country:US
Practice Address - Phone:575-808-8018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1269251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health