Phillip Michael Bass, MDIV, THM, LCMHC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

A10502 Issued in NC

Practice address

1777 Fordham Blvd Ste 204
Chapel Hill, NC 27514-5885

Phone

(919) 283-3137

NPI assigned

Aug 4, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Phillip Michael Shoe Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 6, 2024 through Feb 6, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1407110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711411200000",
    "number": "1912316084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5220 HALLMARK RD STE 403B",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277122058",
            "telephone_number": "919-210-4627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1777 FORDHAM BLVD STE 204",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275145885",
            "telephone_number": "919-283-3137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASS",
        "first_name": "PHILLIP",
        "middle_name": "MICHAEL",
        "credential": "MDIV, THM, LCMHC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-04",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "A10502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PHILLIP",
            "last_name": "SHOE",
            "middle_name": "MICHAEL",
            "credential": "MDIV, THM, LPC, NCC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amir Homayoun Barzin, DO
• Rafiullah Bashiri, DDS, MDS
• Rachel Basinger, PHARMD
• Raghad Basmaeil
• Ayhan Basoglu
• Riana Bass
• Adalberto Bastos de Vasconcellos, DDS, MS, PHD
• Ramon Bataller Alberola, M.D.
• William Mac Batchelor Jr., DDS
• Brittany Bate, PH.D.

• Professional Counselor in Chapel Hill, NC
• Providers in Chapel Hill, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.