Provider Demographics
NPI:1730624776
Name:BASS, CARRIE (BCBA)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:BASS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 VZ COUNTY ROAD 4114
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103-5651
Mailing Address - Country:US
Mailing Address - Phone:903-570-4545
Mailing Address - Fax:
Practice Address - Street 1:171 VZ COUNTY ROAD 4114
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-5651
Practice Address - Country:US
Practice Address - Phone:903-570-4545
Practice Address - Fax:888-518-6656
Is Sole Proprietor?:No
Enumeration Date:2016-12-29
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-17-25371103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst