Individual
CANDACE J TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD, LP
Contact information
Practice address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4264
(417) 761-5279
Mailing address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4264
(417) 761-5279
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2013043233
MO
103TC0700X
Clinical Psychologist
20042661A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490010707
—
MO
Enumeration date
09/01/2010
Last updated
03/12/2020
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