Provider Demographics
NPI:1275729782
Name:SALEM, BASHER M (LPC,LCDC)
Entity Type:Individual
Prefix:MR
First Name:BASHER
Middle Name:M
Last Name:SALEM
Suffix:
Gender:M
Credentials:LPC,LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8211 CREEKRUN VW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3818
Mailing Address - Country:US
Mailing Address - Phone:210-573-6954
Mailing Address - Fax:
Practice Address - Street 1:212 S. NEW BRAUNFLES
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78203
Practice Address - Country:US
Practice Address - Phone:210-573-6954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7782101YA0400X
TX61637101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health