Provider Demographics
NPI:1245276963
Name:BATES, DELORES FROST (MED, LPC)
Entity type:Individual
Prefix:MRS
First Name:DELORES
Middle Name:FROST
Last Name:BATES
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 SANTA FE TRL
Mailing Address - Street 2:#6
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-3063
Mailing Address - Country:US
Mailing Address - Phone:972-789-1504
Mailing Address - Fax:972-780-9521
Practice Address - Street 1:1106 SANTA FE TRL
Practice Address - Street 2:#6
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-3063
Practice Address - Country:US
Practice Address - Phone:972-789-1504
Practice Address - Fax:972-780-9521
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11106101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional