Provider Demographics
NPI:1538305636
Name:BASS, LISA HELLER (LMFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:HELLER
Last Name:BASS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2327 LIME KILN LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-3422
Mailing Address - Country:US
Mailing Address - Phone:502-296-7754
Mailing Address - Fax:502-339-2820
Practice Address - Street 1:2327 LIME KILN LN
Practice Address - Street 2:SUITE A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-3422
Practice Address - Country:US
Practice Address - Phone:502-296-7754
Practice Address - Fax:502-339-2820
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-20
Last Update Date:2008-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0672106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist