Individual
DR. CP KELLY BASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1129 E MAIN ST, 305, WAILUKU, HI 96793-2053
(808) 242-7011
(808) 244-9010
Mailing address
1129 E MAIN ST, 305, WAILUKU, HI 96793-2053
(808) 242-7011
(808) 244-9010
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
292
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000077
HMAA
HI
05
—
01542101
—
HI
01
—
H0000TCBHB
MEDICARE PTAN
HI
Enumeration date
11/15/2006
Last updated
12/05/2012
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