Provider Demographics
NPI:1700189735
Name:BATES, ROSALYN (LCPC)
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5524 W HARRISON ST
Mailing Address - Street 2:OUTPATIENT MENTAL HEALTH
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-5032
Mailing Address - Country:US
Mailing Address - Phone:773-854-5290
Mailing Address - Fax:773-854-5311
Practice Address - Street 1:5524 W HARRISON ST
Practice Address - Street 2:OUTPATIENT MENTAL HEALTH
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-5032
Practice Address - Country:US
Practice Address - Phone:773-854-5290
Practice Address - Fax:773-854-5311
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006830101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional