Provider Demographics
NPI:1013208107
Name:BASSI-COOK, KIMBERLEY ANN (MED, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:ANN
Last Name:BASSI-COOK
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 HEIMANN RD
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-4097
Mailing Address - Country:US
Mailing Address - Phone:724-771-7391
Mailing Address - Fax:
Practice Address - Street 1:1 SETON HILL DR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-1548
Practice Address - Country:US
Practice Address - Phone:724-771-7391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005356101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional