Provider Demographics
NPI:1326118266
Name:BASS, REBECCA D (MA, MFT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:D
Last Name:BASS
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 CAMINO DEL RIO S STE 315
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3784
Mailing Address - Country:US
Mailing Address - Phone:619-280-3430
Mailing Address - Fax:619-280-5420
Practice Address - Street 1:2525 CAMINO DEL RIO S STE 315
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3784
Practice Address - Country:US
Practice Address - Phone:619-280-3430
Practice Address - Fax:619-280-5420
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC #44584106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist