PHILLIP MICHAEL BASS MDIV, THM, LCMHC - NPI 1912316084

Q: What is the provider's specialty?

The provider's specialty is Counselor with taxonomy code 101YP2500X and a focus in Professional.

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About Phillip Michael Bass Mdiv, Thm, Lcmhc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PHILLIP MICHAEL BASS MDIV, THM, LCMHC (NPI 1912316084) is an individual professional provider in Chapel Hill, North Carolina, licensed in North Carolina (A10502) and active in the NPI registry since August 2014.

NPPES Registry Identity

NPI1912316084

Entity TypeIndividualMale

Primary Taxonomy101YP2500X

Provider Legal NamePHILLIP MICHAEL BASSCredential: MDIV, THM, LCMHC

Location Address1777 FORDHAM BLVD STE 204Chapel Hill, NC 27514-5885

Mailing Address5220 Hallmark Rd Ste 403bDurham, NC 27712-2058 · (919) 210-4627

Phone(919) 283-3137

Sole ProprietorNo

Enumeration DateAugust 4, 2014

Last NPPES UpdateMarch 26, 2024

NPPES CertifiedMarch 26, 2024

✔ NPI 1912316084 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers

Taxonomy Code101YP2500X

License✔ Licensed in NC · A10502

1777 FORDHAM BLVD STE 204, Chapel Hill, NC 27514

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Other Names 1

Former Name (1)Phillip Michael Shoe Mdiv, Thm, Lpc, Ncc

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

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Opted out of Medicare

Phillip Michael Bass Mdiv, Thm, Lcmhc has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from February 6, 2024 through February 6, 2026.

Opt-Out Effective DateFebruary 6, 2024

Opt-Out In Effect ThroughFebruary 6, 2026Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ELIJAH BURNER LCMHCA, NCC

Counselor (Mental Health)