Provider Demographics
NPI:1912476094
Name:BASS, JUILIAN MICHAEL-TOWNSLEY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JUILIAN
Middle Name:MICHAEL-TOWNSLEY
Last Name:BASS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3541 ANGUILLA LOOP APT 103
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1793
Mailing Address - Country:US
Mailing Address - Phone:313-231-5335
Mailing Address - Fax:
Practice Address - Street 1:17734 HUNTING BOW CIR STE 101
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-5383
Practice Address - Country:US
Practice Address - Phone:313-231-5335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-18
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10241103TC0700X
MI6301017796103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical