1558612010 NPI number — MRS. JESSICA HART BASS LCPC, LCPAT, ATR-BC

Table of content: MRS. JESSICA HART BASS LCPC, LCPAT, ATR-BC (NPI 1558612010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558612010 NPI number — MRS. JESSICA HART BASS LCPC, LCPAT, ATR-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BASS
Provider First Name:
JESSICA
Provider Middle Name:
HART
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC, LCPAT, ATR-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BYERLY
Provider Other First Name:
JESSICA
Provider Other Middle Name:
HART
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558612010
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8737 BROOKS DR STE 108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21601-7474
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-867-2395
Provider Business Mailing Address Fax Number:
410-443-0842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8737 BROOKS DR STE 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21601-7474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-867-2395
Provider Business Practice Location Address Fax Number:
410-443-0842
Provider Enumeration Date:
09/25/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LGP5307 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 221700000X , with the licence number: ATC139 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: LC6290 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 609550002 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7840093 . This is a "MHNET" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 346646 . This is a "TRICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 522156095 . This is a "HEALTHSMART" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7840093 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 346646 . This is a "MHN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 520202701 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: LM49EA . This is a "BCBS LOCAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 259147-000 . This is a "MAGELLAN BEHAVIORAL HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 522156095 . This is a "CLAIMSBRIDGE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 609500300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: R968 . This is a "BCBS-BLUES" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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