Healthcare Provider Details

I. General information

NPI: 1083854129
Provider Name (Legal Business Name): CHRISTINE ANN BATES PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 03/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 CALLE SOLARES
TUBAC AZ
85646-1952
US

IV. Provider business mailing address

PO BOX 1952
TUBAC AZ
85646-1952
US

V. Phone/Fax

Practice location:
  • Phone: 520-820-1678
  • Fax:
Mailing address:
  • Phone: 520-820-1678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3630
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: