Provider Demographics
NPI:1841152105
Name:BATES, JAELA SHEM
Entity type:Individual
Prefix:
First Name:JAELA
Middle Name:SHEM
Last Name:BATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3774 BEAM AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-9524
Mailing Address - Country:US
Mailing Address - Phone:209-746-3023
Mailing Address - Fax:209-746-3023
Practice Address - Street 1:3774 BEAM AVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-9524
Practice Address - Country:US
Practice Address - Phone:209-746-3023
Practice Address - Fax:209-746-3023
Is Sole Proprietor?:No
Enumeration Date:2025-11-25
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA853930523106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician