Basic Information
| Provider Information | |||||||||
| NPI: | 1326569757 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BASSHAM | ||||||||
| FirstName: | AUBREY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1533 DENNISON RD SW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871052815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059745119 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5201 VENICE AVE NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871132337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059162007 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2017 | ||||||||
| LastUpdateDate: | 07/06/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | X-10138 | NM | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.