=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871996926
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUTH MARIE BASS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2014
-----------------------------------------------------
Last Update Date | 07/30/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | OFFICE OF STUDENT SUPPORT 475 22ND AVENUE ROOM 127
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-313-4192
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | OFFICE OF STUDENT SUPPORT SERVICES 475 22ND AVE
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-313-4192
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MHC447
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------