Provider Demographics
NPI:1619358587
Name:G TATE AND ASSOCIATES,LLC
Entity Type:Organization
Organization Name:G TATE AND ASSOCIATES,LLC
Other - Org Name:MANSFIELD RICHLAND RECOVERY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GERON
Authorized Official - Middle Name:L
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:LICDC-CS
Authorized Official - Phone:414-512-5487
Mailing Address - Street 1:423 BOWMAN ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-1201
Mailing Address - Country:US
Mailing Address - Phone:419-512-5487
Mailing Address - Fax:
Practice Address - Street 1:423 BOWMAN ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-1201
Practice Address - Country:US
Practice Address - Phone:419-512-5487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH965660251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health