Provider Demographics
NPI:1588105027
Name:BASS, ORAH (LPC)
Entity type:Individual
Prefix:
First Name:ORAH
Middle Name:
Last Name:BASS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12500 NW MILITARY HWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1897
Mailing Address - Country:US
Mailing Address - Phone:210-302-6920
Mailing Address - Fax:
Practice Address - Street 1:12500 NW MILITARY HWY
Practice Address - Street 2:SUITE 250
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1897
Practice Address - Country:US
Practice Address - Phone:210-302-6920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72191101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health