Provider Demographics
NPI:1952028011
Name:BENJAMIN ANTONIO TATE
Entity Type:Organization
Organization Name:BENJAMIN ANTONIO TATE
Other - Org Name:WORKING IT OUT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-801-2261
Mailing Address - Street 1:4005 E 11 MILE RD # 159
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-3000
Mailing Address - Country:US
Mailing Address - Phone:586-801-2261
Mailing Address - Fax:
Practice Address - Street 1:19650 HARPER AVE STE 103
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1968
Practice Address - Country:US
Practice Address - Phone:586-801-2261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-20
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty