Individual provider · NPI-1

Jill Lori Basso, MA BCBA

Behavior Analyst · Santa Fe, NM

NPI number1811168172
StatusActive
Last updated in NPPESNov 9, 2020

Details

NPI
1811168172
Entity type
Individual (NPI-1)
Name
Ms. Jill Lori Basso
Credential
MA BCBA
Sex
Female
Sole proprietor
Yes
Enumeration date
Mar 14, 2008
Certification date
Nov 9, 2020
Last updated
Nov 9, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
103K00000X Behavior Analyst1-03-1109NMYes
101Y00000X Counselor––
101Y00000X CounselorCERT#1-03-1109 BCBA–
225700000X Massage Therapist6162NM

Practice location

1705 Medio St.
Santa Fe, NM 87501

Phone 505-986-6114

Mailing address

1705 Medio St.
Santa Fe, NM 87501

Phone 505-986-6114

Other practice locations

4001 Office Court Dr
Santa Fe, NM 87507-4929

Phone 505-395-9611

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