Provider Demographics
NPI:1881455061
Name:BATEMAN, DESHAYLA S (ALC)
Entity type:Individual
Prefix:
First Name:DESHAYLA
Middle Name:S
Last Name:BATEMAN
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:SHAYLA
Other - Middle Name:S
Other - Last Name:BATEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:48 ASPEN CV APT 204
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-0813
Mailing Address - Country:US
Mailing Address - Phone:256-393-3783
Mailing Address - Fax:
Practice Address - Street 1:400 VESTAVIA PKWY
Practice Address - Street 2:PRACTICE WORKS, FLOOR 4
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216
Practice Address - Country:US
Practice Address - Phone:256-393-3783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04730101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health