Provider Demographics
NPI:1548676059
Name:TATE, LAURIE ERIN (MED)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:ERIN
Last Name:TATE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SILVERWOOD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-2845
Mailing Address - Country:US
Mailing Address - Phone:949-923-5323
Mailing Address - Fax:
Practice Address - Street 1:10 SILVERWOOD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-2845
Practice Address - Country:US
Practice Address - Phone:949-923-5323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor