Basic Information
| Provider Information | |||||||||
| NPI: | 1841600400 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TATE | ||||||||
| FirstName: | ANISA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 WEST ST FL 3 | ||||||||
| Address2: | |||||||||
| City: | HOMESTEAD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151202563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124641522 | ||||||||
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| Practice Location | |||||||||
| Address1: | 732 BRADDOCK AVE | ||||||||
| Address2: | |||||||||
| City: | BRADDOCK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123510222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2014 | ||||||||
| LastUpdateDate: | 05/05/2014 | ||||||||
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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 | BH000152 | PA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.