Provider Demographics
NPI:1669531653
Name:TATE, KELI ERIN (MS LPC)
Entity type:Individual
Prefix:MRS
First Name:KELI
Middle Name:ERIN
Last Name:TATE
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:MISS
Other - First Name:KELI
Other - Middle Name:ERIN
Other - Last Name:SELOVEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS LPC
Mailing Address - Street 1:2901 BENTON ROAD
Mailing Address - Street 2:
Mailing Address - City:MT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864
Mailing Address - Country:US
Mailing Address - Phone:618-315-9645
Mailing Address - Fax:
Practice Address - Street 1:#1 DOCTOR PARK ROAD
Practice Address - Street 2:SUITE H
Practice Address - City:MT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864
Practice Address - Country:US
Practice Address - Phone:618-244-0344
Practice Address - Fax:618-244-1455
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor