Provider Demographics
NPI:1508479288
Name:BASH PSYCHOTHERAPY CORPORATION
Entity Type:Organization
Organization Name:BASH PSYCHOTHERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:H
Authorized Official - Last Name:BASH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-542-5687
Mailing Address - Street 1:413 E BERRY RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3317
Mailing Address - Country:US
Mailing Address - Phone:847-542-5687
Mailing Address - Fax:
Practice Address - Street 1:413 E BERRY RD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3317
Practice Address - Country:US
Practice Address - Phone:847-542-5687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health