Individual
MRS. JESSICA HART BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC, LCPAT, ATR-BC
Contact information
Practice address
8737 BROOKS DR STE 108, EASTON, MD 21601-7474
(800) 867-2395
(410) 443-0842
Mailing address
8737 BROOKS DR STE 108, EASTON, MD 21601-7474
(800) 867-2395
(410) 443-0842
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YP2500X
Professional Counselor
Primary
LC6290
MD
101YP2500X
Professional Counselor
LGP5307
MD
221700000X
Art Therapist
ATC139
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
259147-000
MAGELLAN BEHAVIORAL HEALTH
MD
01
—
346646
TRICARE
MD
05
—
520202701
—
MD
01
—
522156095
HEALTHSMART
MD
05
—
609500300
—
MD
05
—
609550002
—
MD
01
—
7840093
MHNET
MD
01
—
LM49EA
BCBS LOCAL
MD
01
—
R968
BCBS-BLUES
MD
Enumeration date
09/25/2012
Last updated
04/23/2019
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