Healthcare Provider Details

I. General information

NPI: 1194914036
Provider Name (Legal Business Name): MRS. SHAWNAH DANELL BASS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S MAIN ST
CROSS PLAINS TX
76443-2581
US

IV. Provider business mailing address

PO BOX 1391
BROWNWOOD TX
76804-1391
US

V. Phone/Fax

Practice location:
  • Phone: 254-725-4311
  • Fax:
Mailing address:
  • Phone: 325-649-4357
  • Fax: 325-646-0919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number23962
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number58301
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: