Provider Demographics
NPI:1629693213
Name:BATES, MICHELE REBECCA (MSSW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:REBECCA
Last Name:BATES
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12037 LA PALMERA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-2007
Mailing Address - Country:US
Mailing Address - Phone:385-204-1677
Mailing Address - Fax:
Practice Address - Street 1:7477 W LAKE MEAD BLVD STE 260
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1027
Practice Address - Country:US
Practice Address - Phone:702-344-0466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1118P-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical