Provider Demographics
NPI:1881252716
Name:BASS, ALYSSA (LMHC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:BASS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:BASSANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1317 EDGEWATER DR # 2768
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6350
Mailing Address - Country:US
Mailing Address - Phone:407-768-3729
Mailing Address - Fax:
Practice Address - Street 1:1317 EDGEWATER DR # 2768
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6350
Practice Address - Country:US
Practice Address - Phone:407-768-3729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15657101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health