Provider Demographics
NPI:1720002884
Name:BATES, ANGELA JANET
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JANET
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 1:4000 E. CHARLESTON BLVD.
Mailing Address - Street 2:B-230
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-6682
Mailing Address - Country:US
Mailing Address - Phone:702-968-5055
Mailing Address - Fax:702-968-5050
Practice Address - Street 1:4000 E. CHARLESTON BLVD.
Practice Address - Street 2:B-230
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-6682
Practice Address - Country:US
Practice Address - Phone:702-968-5055
Practice Address - Fax:702-968-5050
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2699-S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker