Provider Demographics
NPI:1326536442
Name:BASKETT, CORTNE
Entity Type:Individual
Prefix:
First Name:CORTNE
Middle Name:
Last Name:BASKETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 MAXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2408
Mailing Address - Country:US
Mailing Address - Phone:513-559-2014
Mailing Address - Fax:513-559-2944
Practice Address - Street 1:530 MAXWELL AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2408
Practice Address - Country:US
Practice Address - Phone:513-559-2014
Practice Address - Fax:513-559-2944
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)