MEDICARE: MS. SUZANNE LEE BASS L.C.S.W.

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	1351	OK

General Provider Information

NPI Number	:	1831392505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUZANNE LEE BASS L.C.S.W.

Provider Business Mailing Address
First Line	:	1334 N LANSING AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74106-5907
Country	:	US
Telephone Number	:	918-587-2171
Fax Number	:

Provider Business Practice Location Address
First Line	:	1334 NORTH LANSING AVENUE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74106
Country	:	US
Telephone Number	:	918-295-9382
Fax Number	:

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

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	09/20/2021

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