Healthcare Provider Details

I. General information

NPI: 1306779400
Provider Name (Legal Business Name): HATTIE BATES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 S INDUSTRY WAY
MERIDIAN ID
83642-7899
US

IV. Provider business mailing address

690 S INDUSTRY WAY
MERIDIAN ID
83642-7899
US

V. Phone/Fax

Practice location:
  • Phone: 208-922-2207
  • Fax:
Mailing address:
  • Phone: 208-922-2207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8581610
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: