Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 6301006452 | MI |
N | 103TC0700X | Clinical Psychologist | 6301006452 | MI |
N | 103TR0400X | Rehabilitation Psychologist | 6301006452 | MI |
NPI | 1356428981 |
---|---|
Provider Name | Denise G Tate |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S01838 | (02) | MI |