Provider Demographics
NPI:1508079559
Name:BATES, CHRISTINA (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 E BROADWAY ROAD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282
Mailing Address - Country:US
Mailing Address - Phone:480-829-9435
Mailing Address - Fax:480-829-9483
Practice Address - Street 1:2101 E BROADWAY ROAD
Practice Address - Street 2:SUITE 5
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282
Practice Address - Country:US
Practice Address - Phone:480-829-9435
Practice Address - Fax:480-829-9483
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC12145101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health