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General NPI Number Information
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NPI Number | 1053854513
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Entity Type | Individual
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Provider Name | KASEANIA RILEY-BASS PSY.D
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Gender | Female
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Dates
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Enumeration Date | 11/30/2016
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Last Update Date | 11/02/2017
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Provider Practice Location Address
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Address Line | 700 S ZARZAMORA ST STE 301
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City | SAN ANTONIO
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State | TX
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Zip | 78207-5249
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Country | US
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Telephone | 210-556-5016
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Fax |
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Provider Business Mailing Address
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Address Line | 700 S ZARZAMORA ST STE 301
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City | SAN ANTONIO
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State | TX
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Zip | 78207-5249
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Country | US
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Telephone | 210-556-5016
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1952
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License Number State | AL
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