Provider Demographics
NPI:1558612010
Name:BASS, JESSICA HART (LCPC, LCPAT, ATR-BC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:HART
Last Name:BASS
Suffix:
Gender:F
Credentials:LCPC, LCPAT, ATR-BC
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:HART
Other - Last Name:BYERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:8737 BROOKS DR STE 108
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-7474
Mailing Address - Country:US
Mailing Address - Phone:800-867-2395
Mailing Address - Fax:410-443-0842
Practice Address - Street 1:8737 BROOKS DR STE 108
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7474
Practice Address - Country:US
Practice Address - Phone:800-867-2395
Practice Address - Fax:410-443-0842
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP5307101YP2500X
101Y00000X
MDATC139221700000X
MDLC6290101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD609550002Medicaid
MD7840093OtherMHNET
MD346646OtherTRICARE
MD522156095OtherHEALTHSMART
MD7840093OtherAETNA
MD346646OtherMHN
MD520202701Medicaid
MDLM49EAOtherBCBS LOCAL
MD259147-000OtherMAGELLAN BEHAVIORAL HEALTH
MD522156095OtherCLAIMSBRIDGE
MD609500300Medicaid
MDR968OtherBCBS-BLUES