MEDICARE: KENDALL BASSARD LMHC, LCPC

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	101YM0800X	Mental Health Counselor	LC12201	MD
2	101YM0800X	Mental Health Counselor	009331	NY

General Provider Information

NPI Number	:	1669827945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDALL BASSARD LMHC, LCPC

Provider Business Mailing Address
First Line	:	8935 EARLY APRIL WAY APT K
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-2439
Country	:	US
Telephone Number	:	240-274-1474
Fax Number	:

Provider Business Practice Location Address
First Line	:	90 PAINTERS MILL RD STE 203
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-3614
Country	:	US
Telephone Number	:	410-413-4108
Fax Number	:

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

Provider Enumeration Date	:	04/25/2016
Last Update Date	:	03/17/2022

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