Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003007261 |
---|---|
Provider Name | Ms. Judith A Tate |
First Address | Colton, CA 92324-3905 |
Second Address | Colton, CA 92324-3905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2007 |
Last Update Date | 22/04/2020 |