Provider Demographics
NPI:1437604162
Name:BATES, VICKI J (LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:J
Last Name:BATES
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 COUNTY ROAD 118
Mailing Address - Street 2:
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-5417
Mailing Address - Country:US
Mailing Address - Phone:512-809-9055
Mailing Address - Fax:
Practice Address - Street 1:150 S. WEST ST.
Practice Address - Street 2:
Practice Address - City:BERTRAM
Practice Address - State:TX
Practice Address - Zip Code:78605
Practice Address - Country:US
Practice Address - Phone:512-569-1152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73202101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional