MEDICARE: DR. LINDA BUXBAUM BASS PHD, LCMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	358	KS

General Provider Information

NPI Number	:	1194922112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA BUXBAUM BASS PHD, LCMFT

Provider Business Mailing Address
First Line	:	307 S 9TH ST
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64501-2714
Country	:	US
Telephone Number	:	619-920-2677
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 S 18TH ST
Second Line	:	SUITE 222
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-5642
Country	:	US
Telephone Number	:	913-963-0784
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	02/27/2008

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