Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 36431 | TX |
Y | 103T00000X | Psychologist | 36431 | TX |
N | 103TS0200X | School Psychologist | 36431 | TX |
NPI | 1053712232 |
---|---|
Provider Name | Angelique Trask-Tate |
First Address | Houston, TX 77090-2503 |
Second Address | Houston, TX 77090-2503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2014 |
Last Update Date | 01/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NOT APPLICABLE | NONE (01) | TX |