Organization
BASSHAMDBT LLC
Active
Parent organization
MYMENTALSPACE.ORG
Other names
mymentalspace.org
Organization subpart
Yes
Provider details
NPI number
Legal business name
MYMENTALSPACE.ORG
Authorized official
MR. KELLY MICHAEL BASSHAM LMSW (CEO)
(248) 986-2991
Entity
Organization
Contact information
Practice address
200 ELM ST STE 200D, BIRMINGHAM, MI 48009-6322
(248) 986-2991
(248) 294-1237
Mailing address
200 ELM ST STE 200D, BIRMINGHAM, MI 48009-6322
(248) 986-2991
(248) 294-1237
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
11/28/2021
Last updated
11/28/2021
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