Provider Demographics
NPI:1639622657
Name:TATE, KAREN (LLMSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25087 E RUE VERSAILLES DR
Mailing Address - Street 2:APT A
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-4003
Mailing Address - Country:US
Mailing Address - Phone:313-283-2812
Mailing Address - Fax:
Practice Address - Street 1:25087 E RUE VERSAILLES DR
Practice Address - Street 2:APT A
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-4003
Practice Address - Country:US
Practice Address - Phone:313-283-2812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801099535104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker