Provider Demographics
NPI:1063694834
Name:TATE, ELIZABETH V
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:V
Last Name:TATE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3093 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-4030
Mailing Address - Country:US
Mailing Address - Phone:619-665-7925
Mailing Address - Fax:619-284-2443
Practice Address - Street 1:3093 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-4030
Practice Address - Country:US
Practice Address - Phone:619-665-7925
Practice Address - Fax:619-284-2443
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT83318106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist