Provider Demographics
NPI:1326367889
Name:BASS, CINDY (MHR)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:BASS
Suffix:
Gender:F
Credentials:MHR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 W PECAN AVE
Mailing Address - Street 2:
Mailing Address - City:FORT GIBSON
Mailing Address - State:OK
Mailing Address - Zip Code:74434-8944
Mailing Address - Country:US
Mailing Address - Phone:918-348-1113
Mailing Address - Fax:918-681-1116
Practice Address - Street 1:502 E CINCINNATI AVE
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-5535
Practice Address - Country:US
Practice Address - Phone:918-348-1113
Practice Address - Fax:918-681-1116
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker