MEDICARE: MS. YOLANDA BASSETT LPC

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	101YP2500X	Professional Counselor	12215	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7415827	OTHER	TX	AETNA

General Provider Information

NPI Number	:	1427070333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YOLANDA BASSETT LPC

Provider Business Mailing Address
First Line	:	5603 MAPLE SQUARE DR
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-1244
Country	:	US
Telephone Number	:	281-361-7683
Fax Number	:	713-697-4964

Provider Business Practice Location Address
First Line	:	7007 NORTH FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77076-1324
Country	:	US
Telephone Number	:	713-697-4963
Fax Number	:	713-697-4964

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/08/2007

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