Provider Demographics
NPI:1265824908
Name:TATE, TONYA (MS)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 EDWARD OWENS DR
Mailing Address - Street 2:
Mailing Address - City:TERRY
Mailing Address - State:MS
Mailing Address - Zip Code:39170-8921
Mailing Address - Country:US
Mailing Address - Phone:601-954-2421
Mailing Address - Fax:
Practice Address - Street 1:152 EDWARD OWENS DR
Practice Address - Street 2:
Practice Address - City:TERRY
Practice Address - State:MS
Practice Address - Zip Code:39170-8921
Practice Address - Country:US
Practice Address - Phone:601-954-2421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No172V00000XOther Service ProvidersCommunity Health Worker