Basic Information
| Provider Information | |||||||||
| NPI: | 1720002884 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BATES | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | JANET | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4000 E. CHARLESTON BLVD. | ||||||||
| Address2: | B-230 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891046682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029685055 | ||||||||
| FaxNumber: | 7029685050 | ||||||||
| Practice Location | |||||||||
| Address1: | 4000 E. CHARLESTON BLVD. | ||||||||
| Address2: | B-230 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891046682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029685055 | ||||||||
| FaxNumber: | 7029685050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 10/19/2007 | ||||||||
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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 | 104100000X | 2699-S | NV | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.