Provider Demographics
NPI:1720139140
Name:BATES, KARL
Entity type:Individual
Prefix:
First Name:KARL
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 1:7400 NEW LA GRANGE RD
Mailing Address - Street 2:STE 310
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4870
Mailing Address - Country:US
Mailing Address - Phone:502-893-3388
Mailing Address - Fax:
Practice Address - Street 1:214 BRECKENRIDGE LN
Practice Address - Street 2:104
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3868
Practice Address - Country:US
Practice Address - Phone:502-893-3388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-11231041C0700X
IN34003371A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000344331OtherANTHEM BLUE CROSS AND BLUE SHIELD
KY8200100900Medicaid
KY8200100900Medicaid
KY0936501Medicare ID - Type Unspecified