Individual
ANDREW BENJAMIN BASHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NLC
Contact information
Practice address
1003 RUPPLE ST PUEBLO CO 81001, 606, PUEBLO, CO 81001
(719) 371-6196
Mailing address
1003 RUPPLE ST PUEBLO CO 81001, 606, PUEBLO, CO 81001
(719) 371-6196
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
NLC.0109281
CO
Other
Enumeration date
12/16/2018
Last updated
12/16/2018
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