Provider Demographics
NPI:1396596334
Name:BATES, LAURYN ASHLEY
Entity type:Individual
Prefix:
First Name:LAURYN
Middle Name:ASHLEY
Last Name:BATES
Suffix:
Gender:F
Credentials:
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:762-224-0404
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:762-224-0404
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-24-335651106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician