Individual
MANDY MICHELLE BASHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCABA
Contact information
Practice address
3048 S CLIFTON AVE STE 112, SPRINGFIELD, MO 65807-6045
(417) 818-5784
Mailing address
3048 S CLIFTON AVE STE 112, SPRINGFIELD, MO 65807-6045
(417) 818-5784
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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