Provider Demographics
NPI:1811008113
Name:PATE, LEANNE (PHD)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:PATE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 POPLAR AVENUE
Mailing Address - Street 2:#326
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-4442
Mailing Address - Country:US
Mailing Address - Phone:901-921-3206
Mailing Address - Fax:901-682-3797
Practice Address - Street 1:4646 POPLAR AVENUE
Practice Address - Street 2:#326
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4442
Practice Address - Country:US
Practice Address - Phone:901-921-3206
Practice Address - Fax:901-682-3797
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1166103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
3583076Medicare UPIN