Individual
JEB BASHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
411 COURT ST, PORTSMOUTH, OH 45662-3932
(740) 354-6685
Mailing address
411 COURT ST, PORTSMOUTH, OH 45662-3932
(740) 354-6685
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.188953
OH
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
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Other
Enumeration date
06/30/2023
Last updated
07/02/2024
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