Provider Demographics
NPI:1497249718
Name:BATES, MYRANDA ABIGAIL (MA, BCBA)
Entity type:Individual
Prefix:
First Name:MYRANDA
Middle Name:ABIGAIL
Last Name:BATES
Suffix:
Gender:
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 OAKHURST DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3711
Mailing Address - Country:US
Mailing Address - Phone:706-572-6031
Mailing Address - Fax:
Practice Address - Street 1:801 OAKHURST DR
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3711
Practice Address - Country:US
Practice Address - Phone:706-572-6031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst