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General NPI Number Information
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NPI Number | 1073841490
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Entity Type | Individual
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Provider Name | MELISSA D BASS LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/23/2009
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Last Update Date | 11/23/2009
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Provider Practice Location Address
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Address Line | 1211 E NATIONAL AVE
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City | BRAZIL
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State | IN
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Zip | 47834-2717
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Country | US
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Telephone | 812-448-8801
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Fax | 812-446-5302
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Provider Business Mailing Address
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Address Line | PO BOX 4323 620 8TH AVENUE
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City | TERRE HAUTE
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State | IN
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Zip | 47804-0323
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Country | US
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Telephone | 812-231-8315
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Fax | 812-231-8442
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34005861
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License Number State | IN
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