Provider Demographics
NPI:1942613542
Name:SUSAN I BATES
Entity Type:Organization
Organization Name:SUSAN I BATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:I
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCDC
Authorized Official - Phone:512-689-6595
Mailing Address - Street 1:1209 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4132
Mailing Address - Country:US
Mailing Address - Phone:512-689-6595
Mailing Address - Fax:
Practice Address - Street 1:1209 PARKWAY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4132
Practice Address - Country:US
Practice Address - Phone:512-689-6595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11451251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management