Healthcare Provider Details

I. General information

NPI: 1649201500
Provider Name (Legal Business Name): LYNETTE EVE BASSMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W BULLARD AVE STE 101
CLOVIS CA
93612-0861
US

IV. Provider business mailing address

2740 HERNDON AVE
CLOVIS CA
93611-6813
US

V. Phone/Fax

Practice location:
  • Phone: 559-549-4989
  • Fax:
Mailing address:
  • Phone: 559-299-4264
  • Fax: 559-299-1421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY16362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: