Provider Demographics
NPI:1326654187
Name:THERESA M BATEMAN LMSW
Entity Type:Organization
Organization Name:THERESA M BATEMAN LMSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMSW
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BATEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-784-0017
Mailing Address - Street 1:5166 DAYTON DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-4051
Mailing Address - Country:US
Mailing Address - Phone:313-784-0017
Mailing Address - Fax:517-920-4702
Practice Address - Street 1:2265 LIVERNOIS RD STE 260
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1639
Practice Address - Country:US
Practice Address - Phone:313-784-0017
Practice Address - Fax:517-920-4702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty