1568883916 NPI number — ATLAS STEVE BAUTISTA B.A. PSYCHOLOGY

Table of content: ATLAS STEVE BAUTISTA B.A. PSYCHOLOGY (NPI 1568883916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568883916 NPI number — ATLAS STEVE BAUTISTA B.A. PSYCHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAUTISTA
Provider First Name:
ATLAS
Provider Middle Name:
STEVE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
B.A. PSYCHOLOGY
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568883916
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 RED VENTURES DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MILL
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29707-5005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
980-785-0567
Provider Business Mailing Address Fax Number:
980-785-0567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3671 VIA ALLEGRO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89044-1864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-405-2907
Provider Business Practice Location Address Fax Number:
386-405-2907
Provider Enumeration Date:
01/01/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171400000X , with the licence number: 358484125 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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