Provider Demographics
NPI:1164989976
Name:BASNETT, V. RENEE (LASAC)
Entity Type:Individual
Prefix:
First Name:V. RENEE
Middle Name:
Last Name:BASNETT
Suffix:
Gender:F
Credentials:LASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6909 W RAY RD # 15-105
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-1699
Mailing Address - Country:US
Mailing Address - Phone:480-712-8201
Mailing Address - Fax:480-444-1433
Practice Address - Street 1:6909 W RAY RD # 15-105
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-1699
Practice Address - Country:US
Practice Address - Phone:480-712-8201
Practice Address - Fax:480-444-1433
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health