MEDICARE: MICHELE REBECCA BATES MSSW

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	1041C0700X	Clinical Social Worker	1118P-S	NV

General Provider Information

NPI Number	:	1629693213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE REBECCA BATES MSSW

Provider Business Mailing Address
First Line	:	12037 LA PALMERA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-2007
Country	:	US
Telephone Number	:	385-204-1677
Fax Number	:

Provider Business Practice Location Address
First Line	:	7477 W LAKE MEAD BLVD STE 260
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1027
Country	:	US
Telephone Number	:	702-344-0466
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2020
Last Update Date	:	08/04/2020

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