Provider Demographics
NPI:1568998938
Name:BASSILI, KRISTY LYNN (LPA)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNN
Last Name:BASSILI
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 N ELM ST
Mailing Address - Street 2:STE 400
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401
Mailing Address - Country:US
Mailing Address - Phone:336-334-5601
Mailing Address - Fax:
Practice Address - Street 1:122 N ELM ST STE 400
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2842
Practice Address - Country:US
Practice Address - Phone:336-334-5601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5151103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist