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General NPI Number Information
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NPI Number | 1316180078
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Entity Type | Individual
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Provider Name | BRIAN T BASSI M.A. , MFT INTERN,
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Gender | Male
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Dates
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Enumeration Date | 04/10/2009
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Last Update Date | 10/23/2012
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Provider Practice Location Address
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Address Line | 619 S BROADWAY APT B
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City | REDONDO BEACH
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State | CA
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Zip | 90277-4202
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Country | US
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Telephone | 310-733-9679
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Fax |
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Provider Business Mailing Address
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Address Line | 619 S BROADWAY APT B
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City | REDONDO BEACH
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State | CA
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Zip | 90277-4202
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Country | US
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Telephone | 310-733-9679
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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 | 72461
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License Number State | CA
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