MEDICARE: GARRETT BASS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1205535200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARRETT BASS LLC

Provider Business Mailing Address
First Line	:	1037 22ND ST S STE 218
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-2831
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1037 22ND ST S STE 218
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-2831
Country	:	US
Telephone Number	:	205-440-2658
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	GARRETT BASS
Credential	:
Telephone Number	:	205-440-2658

Provider Enumeration Date	:	02/28/2023
Last Update Date	:	04/19/2023

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Directions to “GARRETT BASS LLC ” Practice Location

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