Basic Information
| Provider Information | |||||||||
| NPI: | 1275613697 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATE | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4545 POST OAK PLACE DR | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770273164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139608008 | ||||||||
| FaxNumber: | 7139600965 | ||||||||
| Practice Location | |||||||||
| Address1: | 4545 POST OAK PLACE DR | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770273164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139608008 | ||||||||
| FaxNumber: | 7139600965 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 01/13/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | M0216 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 171340603 | 05 | TX | MEDICAID |