MEDICARE: KELLYN BASS LCSW

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	1041C0700X	Clinical Social Worker	106653	TX
2	1041C0700X	Clinical Social Worker	TPSW4825	FL
3	1041C0700X	Clinical Social Worker	123275	IA
4	1041C0700X	Clinical Social Worker	CSW.09929750	CO

General Provider Information

NPI Number	:	1386309383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLYN BASS LCSW

Provider Business Mailing Address
First Line	:	304 VOYAGER CV
Second Line	:
City	:	KYLE
State	:	TX
Zip	:	78640-6417
Country	:	US
Telephone Number	:	719-291-6099
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 VOYAGER CV
Second Line	:
City	:	KYLE
State	:	TX
Zip	:	78640-6417
Country	:	US
Telephone Number	:	719-291-6099
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2021
Last Update Date	:	01/25/2026

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Directions to “ KELLYN BASS LCSW” Practice Location

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