Provider Demographics
NPI:1073334140
Name:BATES, SHANNON (LPC-A)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 FELDER RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:77880-6171
Mailing Address - Country:US
Mailing Address - Phone:713-208-7819
Mailing Address - Fax:
Practice Address - Street 1:1245 FELDER RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:TX
Practice Address - Zip Code:77880-6171
Practice Address - Country:US
Practice Address - Phone:713-208-7819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93396101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health