Provider Demographics
NPI:1447340633
Name:BASSETT, JODI (LCSW)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:BASSETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 RIDGECREST CIR
Mailing Address - Street 2:BLDG B STE 8
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-5416
Mailing Address - Country:US
Mailing Address - Phone:806-372-1092
Mailing Address - Fax:806-372-7868
Practice Address - Street 1:4200 RIDGECREST CIR
Practice Address - Street 2:BLDG B STE 8
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-5416
Practice Address - Country:US
Practice Address - Phone:806-372-1092
Practice Address - Fax:806-372-7868
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2013-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX582971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical