Provider Demographics
NPI:1164981882
Name:BASSETT, MONICA PEARL (CADC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:PEARL
Last Name:BASSETT
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 W HENSLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-2519
Mailing Address - Country:US
Mailing Address - Phone:918-337-6007
Mailing Address - Fax:918-337-6040
Practice Address - Street 1:610 W HENSLEY BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-2519
Practice Address - Country:US
Practice Address - Phone:918-337-6007
Practice Address - Fax:918-337-6040
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OK450171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator