Healthcare Provider Details

I. General information

NPI: 1497294565
Provider Name (Legal Business Name): ALYSSA BATES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 TREE BLVD STE 6
ST AUGUSTINE FL
32084-5719
US

IV. Provider business mailing address

936 SCHEIDEL WAY
ST AUGUSTINE FL
32084-6617
US

V. Phone/Fax

Practice location:
  • Phone: 904-206-7024
  • Fax:
Mailing address:
  • Phone: 412-652-3022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-16-25232
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-34807
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: