Provider Demographics
NPI:1952120750
Name:TATE, ANTOINETTE (LPC)
Entity type:Individual
Prefix:MRS
First Name:ANTOINETTE
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 MODANO CT
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-1435
Mailing Address - Country:US
Mailing Address - Phone:936-676-5116
Mailing Address - Fax:
Practice Address - Street 1:2606 MODANO CT
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-1435
Practice Address - Country:US
Practice Address - Phone:936-676-5116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91017101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional