Healthcare Provider Details

I. General information

NPI: 1770423683
Provider Name (Legal Business Name): JENNIFER ELAINE BATES LPC ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 CROMWELL DR APT 4206
KYLE TX
78640-3827
US

IV. Provider business mailing address

4700 CROMWELL DR APT 4206
KYLE TX
78640-3827
US

V. Phone/Fax

Practice location:
  • Phone: 832-515-0881
  • Fax:
Mailing address:
  • Phone: 832-515-0881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number101408
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: