Provider Demographics
NPI:1194922112
Name:BASS, LINDA BUXBAUM (PHD, LCMFT)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:BUXBAUM
Last Name:BASS
Suffix:
Gender:F
Credentials:PHD, LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64501-2714
Mailing Address - Country:US
Mailing Address - Phone:619-920-2677
Mailing Address - Fax:
Practice Address - Street 1:155 S 18TH ST
Practice Address - Street 2:SUITE 222
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-5642
Practice Address - Country:US
Practice Address - Phone:913-963-0784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS358106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist