MEDICARE: ROSALYN BATES L.C.P.C

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	101YP2500X	Professional Counselor	180006830	IL

General Provider Information

NPI Number	:	1700189735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALYN BATES L.C.P.C

Provider Business Mailing Address
First Line	:	5524 W HARRISON ST
Second Line	:	OUTPATIENT MENTAL HEALTH
City	:	CHICAGO
State	:	IL
Zip	:	60644-5032
Country	:	US
Telephone Number	:	773-854-5290
Fax Number	:	773-854-5311

Provider Business Practice Location Address
First Line	:	5524 W HARRISON ST
Second Line	:	OUTPATIENT MENTAL HEALTH
City	:	CHICAGO
State	:	IL
Zip	:	60644-5032
Country	:	US
Telephone Number	:	773-854-5290
Fax Number	:	773-854-5311

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

Provider Enumeration Date	:	12/14/2010
Last Update Date	:	12/14/2010

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