MEDICARE: SBATES CREATES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1083245922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SBATES CREATES, LLC

Provider Business Mailing Address
First Line	:	120 EAST FM 544 STE 72
Second Line	:	PMB 153
City	:	MURPHY
State	:	TX
Zip	:	75094
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 N COLLINS BLVD STE 206C
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75080-3625
Country	:	US
Telephone Number	:	469-409-1212
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHELLY BATES
Credential	:
Telephone Number	:	469-409-1212

Provider Enumeration Date	:	01/29/2020
Last Update Date	:	01/29/2020

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Directions to “SBATES CREATES, LLC ” Practice Location

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