Provider Demographics
NPI:1508399916
Name:HUMPHRIES-TATE, ROYLENA MICHELLE
Entity type:Individual
Prefix:MRS
First Name:ROYLENA
Middle Name:MICHELLE
Last Name:HUMPHRIES-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 1:10525 W OCTAVIA CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:LA
Mailing Address - Zip Code:70086-7710
Mailing Address - Country:US
Mailing Address - Phone:504-704-8866
Mailing Address - Fax:
Practice Address - Street 1:576 BELLE TERRE BLVD
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-1715
Practice Address - Country:US
Practice Address - Phone:504-704-8866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator