Provider Demographics
NPI:1902513369
Name:TATE, LEA (LSWAIC)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16909 132ND AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-9570
Mailing Address - Country:US
Mailing Address - Phone:864-735-6577
Mailing Address - Fax:
Practice Address - Street 1:102 23RD AVE SE UNIT 102
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4501
Practice Address - Country:US
Practice Address - Phone:253-987-5561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC613330931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical