MEDICARE: DR. HENRY BASS PHD

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	103T00000X	Psychologist	6352000607	MI
2	103T00000X	Psychologist	P.08990	OH
3	103T00000X	Psychologist	6351004580	MI

General Provider Information

NPI Number	:	1528735180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY BASS PHD

Provider Business Mailing Address
First Line	:	8063 WASHINGTON VILLAGE DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-1847
Country	:	US
Telephone Number	:	937-294-6004
Fax Number	:	937-294-9053

Provider Business Practice Location Address
First Line	:	8063 WASHINGTON VILLAGE DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-1847
Country	:	US
Telephone Number	:	937-294-6004
Fax Number	:	937-294-9053

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

Provider Enumeration Date	:	08/23/2021
Last Update Date	:	07/02/2026

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Directions to “ DR. HENRY BASS PHD” Practice Location

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