Provider Demographics
NPI:1518939487
Name:BASEHORE, KATHLEEN ANN (MA)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ANN
Last Name:BASEHORE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 PENN VALLEY RD
Mailing Address - Street 2:P.O. BOX 208
Mailing Address - City:BERNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19506-8301
Mailing Address - Country:US
Mailing Address - Phone:610-488-7812
Mailing Address - Fax:610-488-7812
Practice Address - Street 1:622 PENN VALLEY RD
Practice Address - Street 2:
Practice Address - City:BERNVILLE
Practice Address - State:PA
Practice Address - Zip Code:19506-8301
Practice Address - Country:US
Practice Address - Phone:610-488-7812
Practice Address - Fax:610-488-7812
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-006731-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist