Provider Demographics
NPI:1447704572
Name:BASSIL, MARIE (MS, LMFT)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:BASSIL
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 CAJON ST STE 3
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4766
Mailing Address - Country:US
Mailing Address - Phone:909-494-2237
Mailing Address - Fax:
Practice Address - Street 1:131 CAJON ST STE 3
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4766
Practice Address - Country:US
Practice Address - Phone:909-494-2237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-05
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93398106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist