Healthcare Provider Details

I. General information

NPI: 1881490936
Provider Name (Legal Business Name): DR. MELISSA BASS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/20/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 W SHAW AVE STE 101
FRESNO CA
93711-3200
US

IV. Provider business mailing address

421 E LOYOLA AVE
FRESNO CA
93720-1643
US

V. Phone/Fax

Practice location:
  • Phone: 559-271-1186
  • Fax:
Mailing address:
  • Phone: 559-355-8289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSBB94028817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: