Provider Demographics
NPI:1710024658
Name:BASHAM, JAMES HOWARD III
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:HOWARD
Last Name:BASHAM
Suffix:III
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:BASHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:2901 CORPORATE CIR
Mailing Address - Street 2:SUITE 300-I
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2266
Mailing Address - Country:US
Mailing Address - Phone:469-635-2872
Mailing Address - Fax:
Practice Address - Street 1:2901 CORPORATE CIR
Practice Address - Street 2:SUITE 300-I
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2266
Practice Address - Country:US
Practice Address - Phone:469-635-2872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19112101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional