Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 16270 | TX |
NPI | 1003149873 |
---|---|
Provider Name | Mrs. Kathleen Margaret Bass |
First Address | Fort Worth, TX 76155-3939 |
Second Address | Fort Worth, TX 76155-3939 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2009 |
Last Update Date | 11/09/2009 |