Provider Demographics
NPI:1528191376
Name:BASS, HEATHER LYNN (LCPC, LMHC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:BASS
Suffix:
Gender:F
Credentials:LCPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N COLLIER BLVD
Mailing Address - Street 2:
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-2725
Mailing Address - Country:US
Mailing Address - Phone:207-561-0558
Mailing Address - Fax:
Practice Address - Street 1:52 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6317
Practice Address - Country:US
Practice Address - Phone:207-561-0558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16996101YP2500X
MECC3150101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional