Provider Demographics
NPI:1275007601
Name:BATES, SHANNON M (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:BATES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 TWIN DOLPHIN DRIVE
Mailing Address - Street 2:SUITE 600-6002
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94065
Mailing Address - Country:US
Mailing Address - Phone:844-542-5481
Mailing Address - Fax:877-237-0105
Practice Address - Street 1:TELEHEALTH FROM HOME
Practice Address - Street 2:1857 BROOKHURST ST
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:458-206-4784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW70857101Y00000X
CA936491041C0700X
ORL129861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor