Provider Demographics
NPI:1043431091
Name:BASSA, MELANIE MARIE (MA)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:MARIE
Last Name:BASSA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 12TH ST STE 222
Mailing Address - Street 2:MCLAIN BUILDING
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3279
Mailing Address - Country:US
Mailing Address - Phone:304-232-0190
Mailing Address - Fax:
Practice Address - Street 1:40 12TH ST STE 222
Practice Address - Street 2:MCLAIN BUILDING
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3279
Practice Address - Country:US
Practice Address - Phone:304-232-0190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV950103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical