Provider Demographics
NPI:1275852212
Name:BATES, LARRY
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:BATES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:CAVE JUNCTION
Mailing Address - State:OR
Mailing Address - Zip Code:97523-9859
Mailing Address - Country:US
Mailing Address - Phone:541-295-4301
Mailing Address - Fax:
Practice Address - Street 1:2340 LAUREL RD
Practice Address - Street 2:
Practice Address - City:CAVE JUNCTION
Practice Address - State:OR
Practice Address - Zip Code:97523-9859
Practice Address - Country:US
Practice Address - Phone:541-295-4301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4521101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional