Provider Demographics
NPI:1326889270
Name:PATRICIA BASS COUNSELING LLC
Entity type:Organization
Organization Name:PATRICIA BASS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:417-254-4459
Mailing Address - Street 1:4460 MOUNT ZION RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65711-2668
Mailing Address - Country:US
Mailing Address - Phone:417-254-4459
Mailing Address - Fax:417-683-2220
Practice Address - Street 1:202 DEAN AVE STE 5
Practice Address - Street 2:
Practice Address - City:AVA
Practice Address - State:MO
Practice Address - Zip Code:65608-5582
Practice Address - Country:US
Practice Address - Phone:417-254-4459
Practice Address - Fax:417-683-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health