Individual provider · Type 1 NPI
Tyra Shavon Tate
Addiction (Substance Use Disorder) Counselor · Ceres, CA
NPI number
1104638808
Active
Practice location
1904 Richland Ave
Ceres, CA 95307-4562
Fax (209) 541-2114
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Addiction (Substance Use Disorder) Counselor Primary | 101YA0400X | 20152 (CA) |
Addiction (Substance Use Disorder) Counselor: Definition to come...
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About NPI 1104638808
Tyra Shavon Tate's National Provider Identifier is 1104638808, issued on Jan 21, 2025. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Ceres, CA. The record was last updated on Jan 21, 2025.