Provider Demographics
NPI:1720559313
Name:TATE, MISTY BROWN (BCBA)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:BROWN
Last Name:TATE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 HINKLE RD
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35045-8890
Mailing Address - Country:US
Mailing Address - Phone:251-510-3858
Mailing Address - Fax:
Practice Address - Street 1:25793 MERCER CT
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-9264
Practice Address - Country:US
Practice Address - Phone:251-510-3858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst