Provider Demographics
NPI:1134282577
Name:BATES, JOAN S (LPC)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:S
Last Name:BATES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 OLYMPIC WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1664
Mailing Address - Country:US
Mailing Address - Phone:636-498-0776
Mailing Address - Fax:636-498-0778
Practice Address - Street 1:115 OLYMPIC WAY
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1664
Practice Address - Country:US
Practice Address - Phone:636-498-0776
Practice Address - Fax:636-498-0778
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000174209101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO494856701Medicaid