Doctor Name: | MRS. KATHLEEN MARGARET BASS |
NPI Number: | 1003149873 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 16270 |
Business Practice Address: | 3901 Kirby Dr #1014 Fort Worth, TX - 761553939 |
Business Phone Number: | 8179150359 |
Business Fax Number: | |
Mailing Address: | 3901 Kirby Dr, #1014 FORT WORTH |
State: | TX |
Postal Code: | 761553939 |
Phone Number: | 8179150359 |
Fax Number: | |
NPI Enumeration Date: | 09/11/2009 |
NPI Last Update Date: | 09/11/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 16270 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |