Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Kimberly Shaffer Tate, PSYD

Individual provider Clinical Psychologist · NPI 1154418903

Dr. Kimberly Shaffer Tate, PSYD is a Clinical Psychologist in Centerville, Ohio. Qualified in 1986, 40 years ago. Practices as a sole proprietor, accepts Medicare assignment and offers telehealth. Licensed in Ohio.

Years since qualifying
40
Licensed in
OH
In the registry since
2006
What do these letters mean?
PSYD — Doctor of Psychology
A doctoral psychologist trained primarily for clinical practice.

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Practice location Address checks out

35 Iron Gate Park Dr
Centerville, OH 45459-0000
Phone: (937) 435-8864
Fax: (937) 435-8264
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence 4664 (OH)

Record details

NPI number1154418903
Entity typeIndividual (Type 1)
GenderFemale
Credentials PSYD
Sole proprietorYes
NPI enumeratedOctober 5, 2006
Last updated in NPPESJuly 9, 2007

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 1986 (40 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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