Provider Demographics
NPI:1891197018
Name:GATES, LOIS (MAC, CADC III, QMHP)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:GATES
Suffix:
Gender:F
Credentials:MAC, CADC III, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 W IDAHO ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5908
Mailing Address - Country:US
Mailing Address - Phone:541-379-9713
Mailing Address - Fax:
Practice Address - Street 1:17 SW FRAZER AVE STE 282
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-0048
Practice Address - Country:US
Practice Address - Phone:541-278-6330
Practice Address - Fax:541-278-5419
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health