Provider Demographics
NPI:1922683986
Name:BATES, ELLIE (M ED)
Entity Type:Individual
Prefix:
First Name:ELLIE
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:MISS
Other - First Name:ELLIE
Other - Middle Name:M
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, LPCC, LMHCA
Mailing Address - Street 1:3834 TAYLORSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1302
Mailing Address - Country:US
Mailing Address - Phone:502-822-1663
Mailing Address - Fax:
Practice Address - Street 1:3834 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1302
Practice Address - Country:US
Practice Address - Phone:502-822-1663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY290645101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional