Provider Demographics
NPI:1407308737
Name:DAVID B TATE PHD LLC
Entity Type:Organization
Organization Name:DAVID B TATE PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:435-656-0506
Mailing Address - Street 1:321 N MALL DR
Mailing Address - Street 2:SUITE I-201
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7323
Mailing Address - Country:US
Mailing Address - Phone:435-656-0506
Mailing Address - Fax:435-272-4009
Practice Address - Street 1:321 N MALL DR
Practice Address - Street 2:SUITE I-201
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7323
Practice Address - Country:US
Practice Address - Phone:435-656-0506
Practice Address - Fax:435-272-4009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-03
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2891262501103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty