MEDICARE: MRS. LAKITIA BATES

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	101Y00000X	Counselor
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1972944403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAKITIA BATES

Provider Business Mailing Address
First Line	:	9408 PEAR ST
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-8601
Country	:	US
Telephone Number	:	405-633-7767
Fax Number	:

Provider Business Practice Location Address
First Line	:	9408 PEAR ST
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-8601
Country	:	US
Telephone Number	:	405-633-7767
Fax Number	:

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

Provider Enumeration Date	:	07/12/2013
Last Update Date	:	01/25/2020

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