| David B Tate Phd Llc | |
|
321 N Mall Dr Suite I-201 St George UT 84790-7323 | |
| (435) 656-0506 | |
| (435) 272-4009 |
| Full Name | David B Tate Phd Llc |
|---|---|
| Speciality | Psychologist |
| Location | 321 N Mall Dr, St George, Utah |
| Authorized Official Name and Position | David Brent Tate (OWNER) |
| Authorized Official Contact | 4356560506 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| David B Tate Phd Llc 321 N Mall Dr Suite I-201 St George UT 84790-7323 Ph: (435) 656-0506 | David B Tate Phd Llc 321 N Mall Dr Suite I-201 St George UT 84790-7323 Ph: (435) 656-0506 |
| NPI Number | 1407308737 |
|---|---|
| Provider Enumeration Date | 11/03/2016 |
| Last Update Date | 11/10/2016 |
| Medicare PECOS PAC ID | 6204119829 |
|---|---|
| Medicare Enrollment ID | O20170206001595 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407308737 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | 2891262501 (Utah) | Primary |
| Provider Name | David Brent Tate |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093992711 PECOS PAC ID: 9830184514 Enrollment ID: I20040421000246 |
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