Provider Demographics
NPI:1265049993
Name:BASSETT, SIDNEY
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:
Last Name:BASSETT
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:SIDNEY
Other - Middle Name:J
Other - Last Name:BASSETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3046 GLENTHORPE LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-4524
Mailing Address - Country:US
Mailing Address - Phone:832-312-5172
Mailing Address - Fax:
Practice Address - Street 1:3046 GLENTHORPE LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-4524
Practice Address - Country:US
Practice Address - Phone:832-312-5172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-27
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11926517-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health