Provider Demographics
NPI:1346682663
Name:BASS, ANTHONY DONALD SR (LPC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:DONALD
Last Name:BASS
Suffix:SR
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 1:205 N 5TH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-1877
Mailing Address - Country:US
Mailing Address - Phone:314-910-0078
Mailing Address - Fax:
Practice Address - Street 1:205 N 5TH ST STE 301
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-1877
Practice Address - Country:US
Practice Address - Phone:314-910-0078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-28
Last Update Date:2013-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013010505101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health