Provider Demographics
NPI:1174622419
Name:BATES, FRED (MED, LCMHC, LADC)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:BATES
Suffix:
Gender:M
Credentials:MED, LCMHC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 ROCKINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-2103
Mailing Address - Country:US
Mailing Address - Phone:603-296-4087
Mailing Address - Fax:603-296-4089
Practice Address - Street 1:302 ROCKINGHAM RD
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-2103
Practice Address - Country:US
Practice Address - Phone:603-296-4087
Practice Address - Fax:603-296-4089
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH460101YA0400X
NH331101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH14Y000994NH01OtherBLUE CROSS BLUE SHIELD NH
NH30420929Medicaid