Provider Demographics
NPI:1861790156
Name:TATE, TIMOTHY C (LPC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:C
Last Name:TATE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6887
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-6887
Mailing Address - Country:US
Mailing Address - Phone:361-980-8821
Mailing Address - Fax:361-980-0863
Practice Address - Street 1:6625 WOOLDRIDGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2916
Practice Address - Country:US
Practice Address - Phone:361-980-8821
Practice Address - Fax:361-980-0863
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65592101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX219472202Medicaid