Provider Demographics
NPI:1396810628
Name:BATES, MARIA THERESA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:THERESA
Last Name:BATES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27501 BLUE LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490
Mailing Address - Country:US
Mailing Address - Phone:707-459-3732
Mailing Address - Fax:
Practice Address - Street 1:MARIA T BATES LCSW
Practice Address - Street 2:660 SO MAIN ST SUITE D
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490
Practice Address - Country:US
Practice Address - Phone:707-459-6108
Practice Address - Fax:707-459-6108
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS115081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6236344OtherUS BEHAVIORAL HEALTH
CAZZZ537342OtherBLUE SHIELD