Provider Demographics
NPI:1720251051
Name:BATES, GLENDA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-4165
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:561-697-9925
Practice Address - Street 1:1201 MAIN ST
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-4165
Practice Address - Country:US
Practice Address - Phone:561-722-7084
Practice Address - Fax:561-697-9925
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9355101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1720251051OtherCOMMERCIAL HEALTH INSURANCE