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General NPI Number Information
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NPI Number | 1205043320
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Entity Type | Individual
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Provider Name | MR. JOHN MICHAEL BASS
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 11/24/2015
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Provider Practice Location Address
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Address Line | 7200 BANCROFT AVE STE 125C
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City | OAKLAND
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State | CA
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Zip | 94605-2415
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Country | US
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Telephone | 510-383-5074
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Fax |
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Provider Business Mailing Address
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Address Line | 7200 BANCROFT AVE STE 125C
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City | OAKLAND
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State | CA
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Zip | 94605-2415
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Country | US
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Telephone |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 89909
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2679
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License Number State | CO
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