Provider Demographics
NPI:1164570628
Name:BATESON, TRESSELA KIMBLE
Entity Type:Individual
Prefix:MRS
First Name:TRESSELA
Middle Name:KIMBLE
Last Name:BATESON
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 1:100 DEVON DR
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-1914
Mailing Address - Country:US
Mailing Address - Phone:864-288-0426
Mailing Address - Fax:
Practice Address - Street 1:20 POWDERHORN RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-3399
Practice Address - Country:US
Practice Address - Phone:864-963-3421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health