Provider Demographics
NPI:1346313509
Name:BATES, JULIE DIANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:DIANE
Last Name:BATES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5212 75TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-2520
Mailing Address - Country:US
Mailing Address - Phone:806-794-3393
Mailing Address - Fax:806-794-3733
Practice Address - Street 1:5212 75TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2520
Practice Address - Country:US
Practice Address - Phone:806-794-3393
Practice Address - Fax:806-794-3733
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00156PMedicare ID - Type Unspecified
TXP25609Medicare UPIN