Provider Demographics
NPI:1700305570
Name:BAUTISTA, CHRISTOPHER ROLANDO
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ROLANDO
Last Name:BAUTISTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438-1701
Mailing Address - Country:US
Mailing Address - Phone:985-839-1050
Mailing Address - Fax:
Practice Address - Street 1:1009 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-1701
Practice Address - Country:US
Practice Address - Phone:985-839-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health