Healthcare Provider Details

I. General information

NPI: 1932244787
Provider Name (Legal Business Name): CHRISTOPHER BLAINE BATEMAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 W CRAIG RD
NORTH LAS VEGAS NV
89032-5115
US

IV. Provider business mailing address

5600 W. ROCHELLE AVE
LAS VEGAS NV
89103
US

V. Phone/Fax

Practice location:
  • Phone: 702-750-0377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4881-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: