Provider Demographics
NPI:1891263265
Name:BATES, CORINNE N (LMHC)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:N
Last Name:BATES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 MAGNAVOX WAY STE 120
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-1553
Mailing Address - Country:US
Mailing Address - Phone:260-483-7207
Mailing Address - Fax:
Practice Address - Street 1:10313 ABOITE CENTER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-5435
Practice Address - Country:US
Practice Address - Phone:260-459-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39005003A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health