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Individual
MANDY MICHELLE BASHAM
Active
Individual
MANDY MICHELLE BASHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCABA
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
2024025674
MO
106E00000X
Assistant Behavior Analyst
0-23-14446
MO
106S00000X
Behavior Technician
RBT-20-143411
MO
Other
Enumeration date
11/19/2020
Last updated
07/08/2024
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