Provider Demographics
NPI:1417831595
Name:BATES, JUSTIN (MA)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:BATES
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DRY RIDGE
Mailing Address - State:KY
Mailing Address - Zip Code:41035-7331
Mailing Address - Country:US
Mailing Address - Phone:502-444-1678
Mailing Address - Fax:
Practice Address - Street 1:4030 SMITH RD STE 200
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-1937
Practice Address - Country:US
Practice Address - Phone:812-655-3058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-02
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2506985101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health