Healthcare Provider Details

I. General information

NPI: 1528735180
Provider Name (Legal Business Name): HENRY BASS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8063 WASHINGTON VILLAGE DR
DAYTON OH
45458-1847
US

IV. Provider business mailing address

8063 WASHINGTON VILLAGE DR
DAYTON OH
45458-1847
US

V. Phone/Fax

Practice location:
  • Phone: 937-294-6004
  • Fax: 937-294-9053
Mailing address:
  • Phone: 937-294-6004
  • Fax: 937-294-9053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6352000607
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP.08990
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6351004580
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: