Provider Demographics
NPI:1205524592
Name:TATE, TYRA (LPC)
Entity type:Individual
Prefix:
First Name:TYRA
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TY
Other - Middle Name:
Other - Last Name:TATE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:74 RIVERBIRCH WAY
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-1595
Mailing Address - Country:US
Mailing Address - Phone:678-542-8086
Mailing Address - Fax:
Practice Address - Street 1:74 RIVERBIRCH WAY
Practice Address - Street 2:
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-1595
Practice Address - Country:US
Practice Address - Phone:415-651-3458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013810101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health