Provider Demographics
NPI:1003496373
Name:BATES, ALEXA MARIE
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:MARIE
Last Name:BATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9318 CLEAR MEADOW DR SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-8119
Mailing Address - Country:US
Mailing Address - Phone:616-826-7938
Mailing Address - Fax:
Practice Address - Street 1:9318 CLEAR MEADOW DR SE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-8119
Practice Address - Country:US
Practice Address - Phone:616-826-7938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011086411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical