Provider Demographics
NPI:1205897121
Name:BRADLEY-BATES, PATRICIA L (LPC, LISAC)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:L
Last Name:BRADLEY-BATES
Suffix:
Gender:F
Credentials:LPC, LISAC
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:L
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, LISAC
Mailing Address - Street 1:10220 N 31ST AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-9581
Mailing Address - Country:US
Mailing Address - Phone:602-843-0000
Mailing Address - Fax:602-997-1305
Practice Address - Street 1:10220 N 31ST AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-9581
Practice Address - Country:US
Practice Address - Phone:602-843-0000
Practice Address - Fax:602-997-1305
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-0052101YA0400X
AZLPC-0757101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional