Provider Demographics
NPI:1265659932
Name:BASS, KENT ALAN (LPC)
Entity Type:Individual
Prefix:MR
First Name:KENT
Middle Name:ALAN
Last Name:BASS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3414 ARCHWAY CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-2304
Mailing Address - Country:US
Mailing Address - Phone:817-446-8548
Mailing Address - Fax:
Practice Address - Street 1:1601 E LAMAR BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-4510
Practice Address - Country:US
Practice Address - Phone:817-265-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14807101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional