Doctor Name: | MS. KATHRYN DIANNE BASS |
NPI Number: | 1598197170 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 001617 |
Business Practice Address: | 1522 Morgan St Keokuk, IA - 526324028 |
Business Phone Number: | 3195240510 |
Business Fax Number: | 3195240609 |
Mailing Address: | 1522 Morgan St, KEOKUK |
State: | IA |
Postal Code: | 526324028 |
Phone Number: | 3195240510 |
Fax Number: | 3195240609 |
NPI Enumeration Date: | 08/06/2013 |
NPI Last Update Date: | 08/06/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 001617 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |