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General NPI Number Information
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NPI Number | 1972109544
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Entity Type | Individual
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Provider Name | RICKEY BATES LCSW
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Gender | Male
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Dates
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Enumeration Date | 12/09/2020
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 11301 WILSHIRE BLVD BLDG 402
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City | LOS ANGELES
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State | CA
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Zip | 90073-1003
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Country | US
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Telephone | 626-558-4754
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Fax |
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Provider Business Mailing Address
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Address Line | 5050 E 2ND ST UNIT 41473
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City | LONG BEACH
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State | CA
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Zip | 90853-5457
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Country | US
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Telephone | 405-209-5703
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW92673
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License Number State | CA
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