Provider Demographics
NPI:1326425018
Name:MASHINI, BASIMA MAZER (MA, LLPC)
Entity Type:Individual
Prefix:
First Name:BASIMA
Middle Name:MAZER
Last Name:MASHINI
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38219 MOUND RD STE 102
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-3466
Mailing Address - Country:US
Mailing Address - Phone:586-939-5016
Mailing Address - Fax:586-939-5194
Practice Address - Street 1:38219 MOUND RD STE 102
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-3466
Practice Address - Country:US
Practice Address - Phone:586-939-5016
Practice Address - Fax:586-939-5194
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014777101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3434247Medicaid