Provider Demographics
NPI:1134423429
Name:BASEDOW, DEBORAH LYNN (LMHC, NCC)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LYNN
Last Name:BASEDOW
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:LYNN
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:2729 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-4015
Mailing Address - Country:US
Mailing Address - Phone:727-698-1806
Mailing Address - Fax:813-902-6081
Practice Address - Street 1:911 S PARSONS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6070
Practice Address - Country:US
Practice Address - Phone:727-698-1806
Practice Address - Fax:813-902-6081
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-01
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9680101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health