Provider Demographics
NPI:1295366847
Name:BATES, CASSANDRA MARIE
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:MARIE
Last Name:BATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:MARIE
Other - Last Name:SANGSLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:519 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5117
Mailing Address - Country:US
Mailing Address - Phone:269-383-0450
Mailing Address - Fax:269-383-2006
Practice Address - Street 1:519 S PARK ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5117
Practice Address - Country:US
Practice Address - Phone:269-383-0450
Practice Address - Fax:269-383-2006
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016730101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional