Provider Demographics
NPI:1043435209
Name:BATES, NANCY JEANNE (MS,MFT)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JEANNE
Last Name:BATES
Suffix:
Gender:F
Credentials:MS,MFT
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:JEANNE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,MFT
Mailing Address - Street 1:3991 COLONETT PL
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-2849
Mailing Address - Country:US
Mailing Address - Phone:805-279-1996
Mailing Address - Fax:
Practice Address - Street 1:484 MOBIL AVE
Practice Address - Street 2:SUITE 13
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6303
Practice Address - Country:US
Practice Address - Phone:805-279-1996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40384106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist