Provider Demographics
NPI:1336397207
Name:BASS, HEATHER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:BASS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 GLENRIDGE PARK PL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-3453
Mailing Address - Country:US
Mailing Address - Phone:502-426-1234
Mailing Address - Fax:502-426-3388
Practice Address - Street 1:6520 GLENRIDGE PARK PL
Practice Address - Street 2:SUITE 1
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-3453
Practice Address - Country:US
Practice Address - Phone:502-426-1234
Practice Address - Fax:502-426-3388
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1592103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical