Provider Demographics
NPI:1245726876
Name:BATES, DOUGLAS ALAN (LCSW, LISAC, ACHP-SW)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:ALAN
Last Name:BATES
Suffix:
Gender:M
Credentials:LCSW, LISAC, ACHP-SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3861 E GLENEAGLE PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-9443
Mailing Address - Country:US
Mailing Address - Phone:623-695-3460
Mailing Address - Fax:
Practice Address - Street 1:3861 E GLENEAGLE PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-9443
Practice Address - Country:US
Practice Address - Phone:623-695-3460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11481101YA0400X
CA286161041C0700X
AZ161521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty