Individual
TYLER BASHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
333 N MICHIGAN AVE, CHICAGO, IL 60601-3901
(312) 815-9660
Mailing address
3146 N SOUTHPORT AVE, CHICAGO, IL 60657-9851
(812) 207-8712
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
07/26/2022
Last updated
07/26/2022
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