Individual
RENEE TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12166 OLD BIG BEND RD, SUITE 204, KIRKWOOD, MO 63122-6844
(314) 822-8888
Mailing address
16 S 74TH ST, BELLEVILLE, IL 62223-2324
(309) 472-0053
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
178.010696
IL
101YP2500X
Professional Counselor
Primary
2014034540
MO
Other
Enumeration date
07/01/2016
Last updated
07/01/2016
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