Provider Demographics
NPI:1255453387
Name:BASS, AMANDA DENISE (LPC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:DENISE
Last Name:BASS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 LONG SLOPE RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-6684
Mailing Address - Country:US
Mailing Address - Phone:214-546-2785
Mailing Address - Fax:
Practice Address - Street 1:2802 LONG SLOPE RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-6684
Practice Address - Country:US
Practice Address - Phone:214-546-2785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61032101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health