Provider Demographics
NPI:1619700762
Name:TATE, MERRITT GRACE WHITE (EDS)
Entity type:Individual
Prefix:
First Name:MERRITT
Middle Name:GRACE WHITE
Last Name:TATE
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 PARK ST APT E
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-3294
Mailing Address - Country:US
Mailing Address - Phone:561-702-7703
Mailing Address - Fax:
Practice Address - Street 1:409 N THOMPSON ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4118
Practice Address - Country:US
Practice Address - Phone:479-750-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool