MEDICARE: CHRISTOPHER BLAINE BATEMAN LCSW

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	4881-C	NV

General Provider Information

NPI Number	:	1932244787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER BLAINE BATEMAN LCSW

Provider Business Mailing Address
First Line	:	5600 W. ROCHELLE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3435 W CRAIG RD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-5115
Country	:	US
Telephone Number	:	702-750-0377
Fax Number	:

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	05/31/2011

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