Provider Demographics
NPI:1265404479
Name:PATE, LAUREL D (LPC)
Entity type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:D
Last Name:PATE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6812 HUNTER VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84128-1164
Mailing Address - Country:US
Mailing Address - Phone:801-252-7578
Mailing Address - Fax:
Practice Address - Street 1:545 W 500 S
Practice Address - Street 2:SUITE 110
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-8105
Practice Address - Country:US
Practice Address - Phone:801-296-0223
Practice Address - Fax:801-296-0240
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT373070-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT373070-6004OtherLICENSE