Individual provider Active NPI

Phishon Bass

  • Mental Health Counselor
  • Jonesboro, AR
National Provider Identifier
1730729146
Registry record updated Aug 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
A2304005 Issued in AR
Practice address
2200 E Matthews Ave
Jonesboro, AR 72401-4347
Phone
(870) 910-3757
NPI assigned
Jan 14, 2020
Last updated
Aug 15, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X A2304005 AR Primary
Case Manager/Care Coordinator 171M00000X NU

Addresses

Primary practice location

2200 E Matthews Ave
Jonesboro, AR 72401-4347

Mailing address

2809 Forest Home Rd
Jonesboro, AR 72401-5320
Phone (866) 972-1268

Other practice location 1

1815 Pleasant Grove Rd
Jonesboro, AR 72405-7870
Phone (870) 933-6886

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
A2304005ARMDMental Health Counselor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692057600000",
    "number": "1730729146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2809 FOREST HOME RD",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724015320",
            "telephone_number": "866-972-1268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 E MATTHEWS AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724014347",
            "telephone_number": "870-910-3757"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1815 Pleasant Grove Rd",
            "address_purpose": "LOCATION",
            "city": "Jonesboro",
            "state": "AR",
            "postal_code": "724057870",
            "country_code": "US",
            "telephone_number": "870-933-6886",
            "fax_number": "870-933-9395",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BASS",
        "first_name": "PHISHON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-14",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": "A2304005",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.