Healthcare Provider Details

I. General information

NPI: 1255453387
Provider Name (Legal Business Name): AMANDA DENISE BASS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E LOOKOUT DR
RICHARDSON TX
75082-4144
US

IV. Provider business mailing address

1001 E LOOKOUT DR
RICHARDSON TX
75082-4144
US

V. Phone/Fax

Practice location:
  • Phone: 972-766-6900
  • Fax:
Mailing address:
  • Phone: 972-766-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number61032
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: