Provider Demographics
NPI:1548575772
Name:PATE, TONNA D (PSYD)
Entity type:Individual
Prefix:DR
First Name:TONNA
Middle Name:D
Last Name:PATE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1096 MECHEM DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-7067
Mailing Address - Country:US
Mailing Address - Phone:575-808-8018
Mailing Address - Fax:
Practice Address - Street 1:1096 MECHEM DR
Practice Address - Street 2:SUITE 208
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-7067
Practice Address - Country:US
Practice Address - Phone:575-808-8018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34160103TC0700X, 103TC2200X, 103TF0200X
NM1269103TC0700X, 103TF0200X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic