Provider Demographics
NPI:1275863300
Name:BASS, CAROL COCHRANE (LMFT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:COCHRANE
Last Name:BASS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3834
Mailing Address - Country:US
Mailing Address - Phone:831-425-2276
Mailing Address - Fax:831-536-1090
Practice Address - Street 1:833 CEDAR ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3834
Practice Address - Country:US
Practice Address - Phone:831-425-2276
Practice Address - Fax:831-536-1090
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43343106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist