Provider Demographics
NPI:1942018866
Name:PHILLIP S. TATE PHD, PLLC
Entity type:Organization
Organization Name:PHILLIP S. TATE PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:S
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:253-455-4626
Mailing Address - Street 1:12303 MERIDIAN E STE 202
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3418
Mailing Address - Country:US
Mailing Address - Phone:253-268-0854
Mailing Address - Fax:253-268-0854
Practice Address - Street 1:12303 MERIDIAN E STE 202
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3418
Practice Address - Country:US
Practice Address - Phone:253-268-0854
Practice Address - Fax:253-268-0854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-23
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical