Provider Demographics
NPI:1932788858
Name:BASS, KELSEY (LMFT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:BASS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1839 E QUEEN CREEK RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-2020
Mailing Address - Country:US
Mailing Address - Phone:602-536-5968
Mailing Address - Fax:
Practice Address - Street 1:1839 E QUEEN CREEK RD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-2020
Practice Address - Country:US
Practice Address - Phone:602-536-5968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-15580106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist