Provider Demographics
NPI:1053110288
Name:BASSETT, JANSEN LARUECARRELL
Entity type:Individual
Prefix:
First Name:JANSEN
Middle Name:LARUECARRELL
Last Name:BASSETT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2785 CASON ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2843
Mailing Address - Country:US
Mailing Address - Phone:317-502-3512
Mailing Address - Fax:
Practice Address - Street 1:7313 EAGLE CREST BLVD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-8157
Practice Address - Country:US
Practice Address - Phone:812-213-7350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician