# BRANDY M BATES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Haven Complete Wellness Services
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184573032
- **Authorized official:** BRANDY M BATES DMSC, PA-C, CAQ-PSYC (OWNER/PROVIDER)
- **Authorized official phone:** (208) 851-9151

## Contact information

- **Practice address:** 2434 S FAIRWAY DR, POCATELLO, ID 83201-2372
- **Practice address phone:** (208) 851-9151
- **Practice address fax:** (208) 977-0029
- **Mailing address:** 2434 S FAIRWAY DR, POCATELLO, ID 83201-2372
- **Mailing address phone:** (208) 851-9151
- **Mailing address fax:** (208) 977-0029

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | NULL | Yes |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | — | Yes |
| 261QM2500X | Medical Specialty Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 01/23/2026
- **Last updated:** 07/15/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 601809507 | — | ID |