Basic Information
| Provider Information | |||||||||
| NPI: | 1609222678 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TATE | ||||||||
| FirstName: | DEBORAH | ||||||||
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| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 SE FEDERAL HWY | ||||||||
| Address2: | |||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34994 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722015219 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 SE FEDERAL HWY | ||||||||
| Address2: | |||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349943823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7723200770 | ||||||||
| FaxNumber: | 7723200181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2016 | ||||||||
| LastUpdateDate: | 05/10/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 59-1051699 | 05 | FL | MEDICAID |