MEDICARE: MS. KIMBERLY BASS LPC

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	0701012805	VA
2	101YP2500X	Professional Counselor	0701012805	VA
3	101YP2500X	Professional Counselor	77327	TX
4	101YA0400X	Addiction (Substance Use Disorder) Counselor	13495	TX
5	101YM0800X	Mental Health Counselor	77327	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0701012805	OTHER	VA	LPC LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790981561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY BASS LPC

Provider Business Mailing Address
First Line	:	PO BOX 1838
Second Line	:
City	:	ALIEF
State	:	TX
Zip	:	77411-1838
Country	:	US
Telephone Number	:	832-894-9359
Fax Number	:

Provider Business Practice Location Address
First Line	:	3707 CYPRESS CREEK PKWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-3526
Country	:	US
Telephone Number	:	832-894-9359
Fax Number	:

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

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	06/08/2024

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