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General NPI Number Information
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NPI Number | 1417831595
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Entity Type | Individual
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Provider Name | JUSTIN BATES MA
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Gender | Male
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Dates
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Enumeration Date | 08/02/2025
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Last Update Date | 08/02/2025
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Provider Practice Location Address
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Address Line | 4030 SMITH RD STE 200
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City | CINCINNATI
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State | OH
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Zip | 45209-1937
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Country | US
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Telephone | 812-655-3058
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Fax |
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Provider Business Mailing Address
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Address Line | 92 S MAIN ST
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City | DRY RIDGE
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State | KY
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Zip | 41035-7331
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Country | US
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Telephone | 502-444-1678
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C.2506985
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License Number State | OH
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