Provider Demographics
NPI:1871718643
Name:BASS, WILMA (MFT)
Entity type:Individual
Prefix:
First Name:WILMA
Middle Name:
Last Name:BASS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533A CASTRO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-2511
Mailing Address - Country:US
Mailing Address - Phone:415-821-1682
Mailing Address - Fax:415-821-1241
Practice Address - Street 1:533A CASTRO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-2511
Practice Address - Country:US
Practice Address - Phone:415-821-1682
Practice Address - Fax:415-821-1241
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC21174106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist