Provider Demographics
NPI:1437781325
Name:BATES, LATONYA DEONA
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:DEONA
Last Name:BATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 BATES RD
Mailing Address - Street 2:
Mailing Address - City:FRIERSON
Mailing Address - State:LA
Mailing Address - Zip Code:71027-2016
Mailing Address - Country:US
Mailing Address - Phone:707-350-5523
Mailing Address - Fax:318-872-2088
Practice Address - Street 1:305 E PINECREST DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-7205
Practice Address - Country:US
Practice Address - Phone:903-472-5910
Practice Address - Fax:318-872-2088
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253Z00000X, 374U00000X, 251E00000X
OK101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator