Provider Demographics
NPI:1649411810
Name:BASS, SHARON DIANE (RN LMFT)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:DIANE
Last Name:BASS
Suffix:
Gender:F
Credentials:RN LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 SPRING OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-9137
Mailing Address - Country:US
Mailing Address - Phone:707-546-6223
Mailing Address - Fax:
Practice Address - Street 1:2633 SPRING OAKS DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-9137
Practice Address - Country:US
Practice Address - Phone:707-546-6223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16983106H00000X
CA236118163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist