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General NPI Number Information
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NPI Number | 1720698624
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Entity Type | Individual
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Provider Name | CRISTIN BATES
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Gender | Female
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Dates
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Enumeration Date | 08/05/2020
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Last Update Date | 08/05/2020
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Provider Practice Location Address
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Address Line | 284 MARTIN ST
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City | TWIN FALLS
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State | ID
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Zip | 83301-4542
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Country | US
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Telephone | 208-404-4131
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Fax |
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Provider Business Mailing Address
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Address Line | 2011 N KENNEDY ST
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City | JEROME
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State | ID
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Zip | 83338-4913
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Country | US
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Telephone | 208-404-4131
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LAMFT-7126
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License Number State | ID
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