Individual
DR. ETHEL ANN BASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, CADC, CODP1
Contact information
Practice address
45 W 111TH ST, CHICAGO, IL 60628-4200
(773) 995-1919
Mailing address
4747 LINCOLN MALL DR STE 410, MATTESON, IL 60443-3821
(630) 499-6197
(630) 423-7873
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
24935
IL
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
24935
IL
101YM0800X
Mental Health Counselor
24935
IL
Other
Enumeration date
07/31/2024
Last updated
05/31/2025
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