Provider Demographics
NPI:1295393155
Name:TATE, HEATHER ELISE (LPC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ELISE
Last Name:TATE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1486
Mailing Address - Country:US
Mailing Address - Phone:814-591-3593
Mailing Address - Fax:
Practice Address - Street 1:330 WAYNE AVE
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1486
Practice Address - Country:US
Practice Address - Phone:814-591-3593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011425101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health