Individual
MARY E BASHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
16535 W BLUEMOUND RD, SUITE 200, BROOKFIELD, WI 53005-5936
(262) 542-3255
(262) 821-6180
Mailing address
2350 WOODMOOR LN, BROOKFIELD, WI 53045-4259
(262) 796-1045
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
468-124
WI
Other
Enumeration date
10/05/2006
Last updated
09/24/2008
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