Individual
KISHA BASHKIHARATEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
24691 STEWART ST, LOMA LINDA, CA 92354-2744
(985) 628-0682
Mailing address
24691 STEWART ST, LOMA LINDA, CA 92354-2744
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
10181
CA
101YP2500X
Professional Counselor
1762
CA
101YP2500X
Professional Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10181
BOARD OF BEHAVIORAL SCIENCES
CA
01
—
1762
BOARD OF BEHAVIORAL SCIENCES
CA
Enumeration date
11/23/2016
Last updated
08/16/2022
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