Provider Demographics
NPI:1942364112
Name:BATES, DAVID B (LPC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:BATES
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10337
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99710-0337
Mailing Address - Country:US
Mailing Address - Phone:907-457-6002
Mailing Address - Fax:
Practice Address - Street 1:122 10TH AVENUE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701
Practice Address - Country:US
Practice Address - Phone:907-457-6002
Practice Address - Fax:907-457-3610
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK408101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional