CP Kelly Bass, PHD
Individual provider Active NPI Clinical Psychologist · Wailuku, HI
NPI 1457423352 · NPPES record last updated Dec 5, 2012
Key facts
- NPI
- 1457423352
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 292 (HI)
- Practice address
- 1129 E Main St
305
Wailuku, HI 96793-2053 - Phone
- (808) 242-7011
- Fax
- (808) 244-9010
- NPI assigned
- Nov 15, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 292 | HI | MD | Marriage & Family Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 292 | HI | Yes |
Addresses
Primary practice location
1129 E Main St
305
Wailuku, HI 96793-2053
Mailing address
1129 E Main St
305
Wailuku, HI 96793-2053
Phone (808) 242-7011
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000077 | Other | HI | HMAA |
| 01542101 | Medicaid | HI | |
| H0000TCBHB | Other | HI | MEDICARE PTAN |
Other providers in Wailuku, HI
- Sydney Madeline Barnes
- Charles Anthony Barone
- Karen T. Barretto
- Felipe Castillo Barroga III
- Helen A Barrow
- Wilma Garduque Batino
- Yvette Michele Batteux
- Cienna Battiest
- Bayada Home Care
- Bayada Home Care
All providers in Wailuku, HI · Clinical Psychologist in Hawaii
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 5, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.