Provider Demographics
NPI:1346388295
Name:BATES, BRAD L (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:L
Last Name:BATES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 N 30TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-3319
Mailing Address - Country:US
Mailing Address - Phone:253-383-0101
Mailing Address - Fax:253-383-0149
Practice Address - Street 1:2102 N 30TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-3319
Practice Address - Country:US
Practice Address - Phone:253-383-0101
Practice Address - Fax:253-383-0149
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1546103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8859862Medicare ID - Type Unspecified