Individual
LACEY BASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2250 LAKE AVE STE 100, FORT WAYNE, IN 46805-5352
(260) 543-0009
Mailing address
2250 LAKE AVE STE 100, FORT WAYNE, IN 46805-5352
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
03/07/2024
Last updated
03/07/2024
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