Provider Demographics
NPI:1154794402
Name:TATE, JOCELYN (LMT #3225)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:LMT #3225
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 SPAIN RD NE
Mailing Address - Street 2:E
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1883
Mailing Address - Country:US
Mailing Address - Phone:505-249-2481
Mailing Address - Fax:
Practice Address - Street 1:11000 SPAIN RD NE
Practice Address - Street 2:E
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1883
Practice Address - Country:US
Practice Address - Phone:505-249-2481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLMT #3225174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMLMT #3225OtherLICENSED MASSAGE THERAPIST