Provider Demographics
NPI:1073152096
Name:BASS, JULIE M (LCPC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:BASS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1238
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-1238
Mailing Address - Country:US
Mailing Address - Phone:406-219-8724
Mailing Address - Fax:877-232-9719
Practice Address - Street 1:1601 2ND AVE N STE 400
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3276
Practice Address - Country:US
Practice Address - Phone:406-219-8724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-41371101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional