Provider Demographics
NPI:1073571402
Name:BATES, KERRI MICHELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KERRI
Middle Name:MICHELLE
Last Name:BATES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450-3101
Mailing Address - Country:US
Mailing Address - Phone:940-549-2259
Mailing Address - Fax:940-549-2886
Practice Address - Street 1:617 3RD ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450-3101
Practice Address - Country:US
Practice Address - Phone:940-549-2259
Practice Address - Fax:940-691-0062
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32234103TC0700X
OK955103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87204AOtherBLUE CROSS BLUE SHIELD
TX274010OtherCOMPSYCH
TX9339657OtherPHCS
TX274010OtherCOMPSYCH