Provider Demographics
NPI:1376258962
Name:CATES, TAWAUN TRAVELLE (SAC-IT)
Entity Type:Individual
Prefix:
First Name:TAWAUN
Middle Name:TRAVELLE
Last Name:CATES
Suffix:
Gender:M
Credentials:SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 W SUNNY LN
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-9091
Mailing Address - Country:US
Mailing Address - Phone:608-741-4500
Mailing Address - Fax:
Practice Address - Street 1:203 W SUNNY LN
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-9091
Practice Address - Country:US
Practice Address - Phone:608-741-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19606101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)