MEDICARE: KRISTA KAY BASS

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	114138	TX

General Provider Information

NPI Number	:	1730014424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA KAY BASS

Provider Business Mailing Address
First Line	:	10651 STEPPINGTON DR APT 2064
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-4658
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6301 GASTON AVE STE 1209
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-3958
Country	:	US
Telephone Number	:	214-785-0086
Fax Number	:

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

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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Directions to “ KRISTA KAY BASS ” Practice Location

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