Provider Demographics
NPI:1407564966
Name:TATE, TYRA (LMFT)
Entity Type:Individual
Prefix:
First Name:TYRA
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16520 NW 17TH CT
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-6606
Mailing Address - Country:US
Mailing Address - Phone:305-209-6090
Mailing Address - Fax:
Practice Address - Street 1:16520 NW 17TH CT
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-6606
Practice Address - Country:US
Practice Address - Phone:305-209-6090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4272106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist