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General NPI Number Information
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NPI Number | 1720740962
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Entity Type | Individual
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Provider Name | HAROLD EDWARD BATES SR SR. LADAC II , MAC
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Gender | Male
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 5565 BROOK SHADE LN
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City | MEMPHIS
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State | TN
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Zip | 38125-4198
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Country | US
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Telephone | 901-308-9271
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Fax |
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Provider Business Mailing Address
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Address Line | 1910 MADISON AVE # 3013
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City | MEMPHIS
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State | TN
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Zip | 38104-2620
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Country | US
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Telephone | 901-308-9271
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LDC619
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License Number State | TN
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