Provider Demographics
NPI:1245786698
Name:TONYA L. BASSETT COUNSELING, INC
Entity Type:Organization
Organization Name:TONYA L. BASSETT COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BASSETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:309-831-9558
Mailing Address - Street 1:200 W MONROE ST STE 25
Mailing Address - Street 2:SUITE 302-A
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3922
Mailing Address - Country:US
Mailing Address - Phone:309-831-9558
Mailing Address - Fax:
Practice Address - Street 1:200 W MONROE ST STE 25
Practice Address - Street 2:SUITE 302-A
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3922
Practice Address - Country:US
Practice Address - Phone:309-831-9558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149013779251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1041C0700XOtherLICENSED CLINICAL SOCIAL WORKER