Organization
LEE BASCOM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEE BASCOM LCSW (OWNER/ LCSW)
(314) 229-3483
Entity
Organization
Contact information
Practice address
1121 OLIVETTE EXECUTIVE PKWY, SUITE 205, SAINT LOUIS, MO 63132-3254
(314) 229-3483
Mailing address
841 N KIRKWOOD RD, SAINT LOUIS, MO 63122-2639
(314) 229-3483
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2004031739
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500073730
—
MO
Enumeration date
05/02/2013
Last updated
01/28/2021
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