=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427070333
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YOLANDA BASSETT LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7007 NORTH FWY
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77076-1324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-697-4963
-----------------------------------------------------
Fax | 713-697-4964
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5603 MAPLE SQUARE DR
-----------------------------------------------------
City | KINGWOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77339-1244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-361-7683
-----------------------------------------------------
Fax | 713-697-4964
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 12215
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------