# BASS WELLNESS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578280293
- **Authorized official:** MR. JUSTIN WILLIAM SHAW NP-P, PMHNP-BC (CO-FOUNDER)
- **Authorized official phone:** (917) 575-5662

## Contact information

- **Practice address:** 1180 6TH AVE FL 8, NEW YORK, NY 10036-8401
- **Practice address phone:** (917) 923-0569
- **Practice address fax:** (469) 414-5292
- **Mailing address:** 263 FRANKLIN AVE APT 1B, BROOKLYN, NY 11205-3554
- **Mailing address phone:** (917) 575-5662
- **Mailing address fax:** (469) 414-5292

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 10/24/2022
- **Last updated:** 10/24/2022