Provider Demographics
NPI:1811795719
Name:BATES, STACIE (LPC ASSOCIATE)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:BATES
Suffix:
Gender:
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 163781
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-3781
Mailing Address - Country:US
Mailing Address - Phone:682-651-7621
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 163781
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76161-3781
Practice Address - Country:US
Practice Address - Phone:682-651-7621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX98060101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health