Healthcare Provider Details

I. General information

NPI: 1366094583
Provider Name (Legal Business Name): THOMAS CHARLES BATES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 DICK HAYES RD
SCOTTSBORO AL
35769-7309
US

IV. Provider business mailing address

PO BOX 106 PO BOX 106
SECTION AL
35771-0106
US

V. Phone/Fax

Practice location:
  • Phone: 256-763-1307
  • Fax:
Mailing address:
  • Phone: 256-763-1307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC04238
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: