Provider Demographics
NPI:1851447189
Name:BASSIL, DEEDEE DINAH (MC)
Entity Type:Individual
Prefix:MRS
First Name:DEEDEE
Middle Name:DINAH
Last Name:BASSIL
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 N 12TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-4932
Mailing Address - Country:US
Mailing Address - Phone:602-550-0445
Mailing Address - Fax:
Practice Address - Street 1:4150 N 12TH ST STE A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-4932
Practice Address - Country:US
Practice Address - Phone:602-550-0445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC10770101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health