Provider Demographics
NPI:1508537770
Name:PATE, GEORGE ALLEN JR
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ALLEN
Last Name:PATE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432057 STATE HIGHWAY 3
Mailing Address - Street 2:
Mailing Address - City:FORT TOWSON
Mailing Address - State:OK
Mailing Address - Zip Code:74735-7506
Mailing Address - Country:US
Mailing Address - Phone:580-372-6572
Mailing Address - Fax:
Practice Address - Street 1:432057 STATE HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:FORT TOWSON
Practice Address - State:OK
Practice Address - Zip Code:74735-7506
Practice Address - Country:US
Practice Address - Phone:580-372-6572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
OK12151802103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician