Individual
DR. KIMBERLY SHAFFER TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
35 IRON GATE PARK DR., CENTERVILLE, OH 45459-0000
(937) 435-8864
(937) 435-8264
Mailing address
PO BOX 41158, CENTERVILLE, OH 45441-0158
(937) 435-8864
(937) 435-8264
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
4664
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
028545000
MAGELLAN PIN
OH
01
—
172428110968
HUMANA PIN
OH
01
—
22000000356767
ANTHEM PIN
OH
01
—
281859
VALUE OPTIONS
OH
Enumeration date
10/05/2006
Last updated
07/09/2007
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