Individual
EDWIN WALLACE BASHAM JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED.D.
Contact information
Practice address
3505 OLSEN BLVD, SUITE 224, AMARILLO, TX 79109-3042
(806) 354-0411
(806) 354-0466
Mailing address
3505 OLSEN BLVD, SUITE 224, AMARILLO, TX 79109-3042
(806) 354-0411
(806) 354-0466
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
22625
TX
Other
Enumeration date
02/22/2007
Last updated
07/09/2007
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