Provider Demographics
NPI:1598868622
Name:BATES, ROBERT R (LLP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:BATES
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 ALI DR DEPT 320
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-5193
Mailing Address - Country:US
Mailing Address - Phone:810-428-0079
Mailing Address - Fax:810-426-0009
Practice Address - Street 1:5445 ALI DR DEPT 320
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-5193
Practice Address - Country:US
Practice Address - Phone:810-428-0079
Practice Address - Fax:810-426-0009
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002113103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist