Provider Demographics
NPI:1417223231
Name:BATEMAN, KARL L (LCSW)
Entity type:Individual
Prefix:MR
First Name:KARL
Middle Name:L
Last Name:BATEMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4465 BELLA VISTA CIR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-9273
Mailing Address - Country:US
Mailing Address - Phone:801-548-3972
Mailing Address - Fax:
Practice Address - Street 1:1970 E 3RD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5056
Practice Address - Country:US
Practice Address - Phone:505-414-0239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7775760-3502101YA0400X, 101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health