Healthcare Provider Details

I. General information

NPI: 1205897121
Provider Name (Legal Business Name): PATRICIA L. BRADLEY-BATES LPC, LISAC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: PATRICIA L. BATES LPC, LISAC

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10220 N 31ST AVE SUITE 205
PHOENIX AZ
85051-9581
US

IV. Provider business mailing address

10220 N 31ST AVE SUITE 205
PHOENIX AZ
85051-9581
US

V. Phone/Fax

Practice location:
  • Phone: 602-843-0000
  • Fax: 602-997-1305
Mailing address:
  • Phone: 602-843-0000
  • Fax: 602-997-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLISAC-0052
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-0757
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: