Basic Information
| Provider Information | |||||||||
| NPI: | 1548492374 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAATIN | ||||||||
| FirstName: | ADEELAH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 559 16TH ST | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946121515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103186137 | ||||||||
| FaxNumber: | 5105694589 | ||||||||
| Practice Location | |||||||||
| Address1: | 559 16TH ST | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103186137 | ||||||||
| FaxNumber: | 5105694589 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2009 | ||||||||
| LastUpdateDate: | 09/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 10017056 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1548492374 | 05 | CA | MEDICAID |