Provider Demographics
NPI:1346448651
Name:FARLEY-BATES, NINA DIANA (LCSW, DBH)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:DIANA
Last Name:FARLEY-BATES
Suffix:
Gender:F
Credentials:LCSW, DBH
Other - Prefix:MRS
Other - First Name:NINA
Other - Middle Name:DIANA
Other - Last Name:HOFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:40034 ROAD 415
Mailing Address - Street 2:
Mailing Address - City:COARSEGOLD
Mailing Address - State:CA
Mailing Address - Zip Code:93614-8832
Mailing Address - Country:US
Mailing Address - Phone:559-760-5798
Mailing Address - Fax:559-689-3354
Practice Address - Street 1:49063 ROAD 426 STE A
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:CA
Practice Address - Zip Code:93644-9487
Practice Address - Country:US
Practice Address - Phone:559-760-0484
Practice Address - Fax:559-689-3354
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-08
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS243581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1346448651Medicaid