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DEIDRA BASS

Mental Health >> Counselor >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1851749857

Individual Registrant:
 DEIDRA  BASS 
Gender: F
Sole Proprietor

Location and contact information for practice:
525 NW LAKE WHITNEY PL  PORT SAINT LUCIE, FL 34986-1605 US
Tel: 772-446-1148  Fax: --

Contact information for business:
525 NW LAKE WHITNEY PL  PORT SAINT LUCIE, FL 34986-1605 US
Tel: 772-446-1148  Fax: --

Registration Information:
NPI: 1851749857
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101YM0800XBehavioral Health & Social Service Providers
Counselor
Mental Health
FL900341538

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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