Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 289126-2501 | UT |
NPI | 1093992711 |
---|---|
Provider Name | David Brent Tate |
First Address | St George, UT 84790-7302 |
Second Address | St George, UT 84790-7302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2008 |
Last Update Date | 03/11/2016 |