MEDICARE: MRS. BRANDALYN BATES LPCC

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	C.1000484	OH
2	101YM0800X	Mental Health Counselor	E.1801001	OH
3	101YP2500X	Professional Counselor	C.1000484	OH
4	106H00000X	Marriage & Family Therapist	C.1000484	OH

General Provider Information

NPI Number	:	1992124630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRANDALYN BATES LPCC

Provider Business Mailing Address
First Line	:	4136 NEW RD
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44515-4631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3517 STONELEIGH WALK
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30038-3291
Country	:	US
Telephone Number	:	330-397-8870
Fax Number	:

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

Provider Enumeration Date	:	04/09/2014
Last Update Date	:	04/09/2026

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