Provider Demographics
NPI:1407494065
Name:BATES-PUALUAN, ROBIN (LMFT, LPCC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:BATES-PUALUAN
Suffix:
Gender:F
Credentials:LMFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 S BASCOM AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-3279
Mailing Address - Country:US
Mailing Address - Phone:408-874-6574
Mailing Address - Fax:
Practice Address - Street 1:2155 S BASCOM AVE STE 203
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-3279
Practice Address - Country:US
Practice Address - Phone:408-874-6574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA420101YP2500X
CA52419106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional