Individual
DEBORAH A BASTEDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LLP, LPC, NCC
Contact information
Practice address
52188 VAN DYKE AVE, STE 300, SHELBY TOWNSHIP, MI 48316-3567
(586) 803-1583
(248) 682-7486
Mailing address
1069 PELHAM BLVD, WATERFORD, MI 48328-4262
(248) 787-3916
(248) 682-7486
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301011762
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2544866D1A
TRICARE
MI
01
—
287751
MHN
MI
Enumeration date
07/18/2006
Last updated
07/08/2007
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