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General NPI Number Information
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NPI Number | 1265317523
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Entity Type | Organization
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Legal Business Name | CLARIPATH PSYCHIATRY PLLC
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Dates
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Enumeration Date | 08/07/2025
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 330 S MAIN ST
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City | ANNA
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State | IL
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Zip | 62906-1242
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Country | US
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Telephone | 618-270-7879
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Fax | 949-864-3553
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Provider Business Mailing Address
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Address Line | 2501 CHATHAM RD # 4358
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4188
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Country | US
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Telephone | 618-270-7879
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Fax | 949-864-3553
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MR. KEITH SAMUEL BASS
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Credential | PMHNP-BC
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Telephone | 618-270-7879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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