Healthcare Provider Details

I. General information

NPI: 1760449946
Provider Name (Legal Business Name): NANCY RYER BASS M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2006
Last Update Date: 11/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 CAPITAL CIR NE
TALLAHASSEE FL
32308-8401
US

IV. Provider business mailing address

3405 CHEROKEE RIDGE TRL
TALLAHASSEE FL
32312-3607
US

V. Phone/Fax

Practice location:
  • Phone: 850-510-2831
  • Fax: 850-893-1806
Mailing address:
  • Phone: 850-893-1806
  • Fax: 850-893-1806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMH 8447
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC 2386
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMH 8447
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLPC 2386
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 8447
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC 2386
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMH 8447
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC 2386
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: