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NPI Code Detail

MEDICARE: PHILLIP MICHAEL BASS MDIV, THM, LCMHC

MEDICARE: PHILLIP MICHAEL BASS MDIV, THM, LCMHC
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
1101YP2500XProfessional CounselorA10502NC

General Provider Information

NPI Number : 1912316084
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILLIP MICHAEL BASS MDIV, THM, LCMHC
Provider Business Mailing Address
First Line : 5220 HALLMARK RD STE 403B
Second Line :
City : DURHAM
State : NC
Zip : 27712-2058
Country : US
Telephone Number : 919-210-4627
Fax Number :
Provider Business Practice Location Address
First Line : 1777 FORDHAM BLVD STE 204
Second Line :
City : CHAPEL HILL
State : NC
Zip : 27514-5885
Country : US
Telephone Number : 919-283-3137
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2014
Last Update Date : 03/26/2024

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