Provider Demographics
NPI:1841690807
Name:BASSANO, STEPHANIE ANN (LCDC, CCJP, DOT/SAP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:BASSANO
Suffix:
Gender:F
Credentials:LCDC, CCJP, DOT/SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 E CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-3309
Mailing Address - Country:US
Mailing Address - Phone:361-576-4673
Mailing Address - Fax:361-576-6557
Practice Address - Street 1:802 E CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3309
Practice Address - Country:US
Practice Address - Phone:361-576-4673
Practice Address - Fax:361-576-6557
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9901101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)