Individual
CARMEN TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2803 LARKSPUR LN, HAZEL CREST, IL 60429-2145
(708) 608-3241
Mailing address
2803 LARKSPUR LN, HAZEL CREST, IL 60429-2145
(708) 305-1193
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180009380
—
104100000X
Social Worker
150102674
—
171M00000X
Case Manager/Care Coordinator
42113793
—
225C00000X
Rehabilitation Counselor
110546
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
47-4411020
PRIVATE
—
05
—
47-4411020
—
IL
Enumeration date
07/21/2020
Last updated
07/21/2020
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