Individual
LESLIE BASHIOUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4650 S NATIONAL AVE STE A4, SPRINGFIELD, MO 65810-2893
(417) 208-9840
Mailing address
1443 KNIGHTSBRIDGE RD, MARSHFIELD, MO 65706-7547
(417) 612-3853
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2015034348
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629441944
—
MO
Enumeration date
11/09/2015
Last updated
05/10/2023
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