Provider Demographics
NPI:1013901818
Name:BATES, GEORGE A (MS, LCPC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:A
Last Name:BATES
Suffix:
Gender:M
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 EAGLE CTR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1947
Mailing Address - Country:US
Mailing Address - Phone:618-624-1234
Mailing Address - Fax:618-624-2027
Practice Address - Street 1:8 EAGLE CENTER
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1947
Practice Address - Country:US
Practice Address - Phone:618-624-1234
Practice Address - Fax:618-624-2027
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health