Individual
LAURA TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3101C S KIMBROUGH AVE, SPRINGFIELD, MO 65807-5011
(417) 866-7773
Mailing address
3101C S KIMBROUGH AVE, SPRINGFIELD, MO 65807-5011
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2016040307
MO
Other
Enumeration date
11/14/2016
Last updated
11/14/2016
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