Provider Demographics
NPI:1801782107
Name:DR. KISHA BASHKIHARATEE LICENSED PROFESSIONAL CLINICAL COUNSELOR, PC
Entity type:Organization
Organization Name:DR. KISHA BASHKIHARATEE LICENSED PROFESSIONAL CLINICAL COUNSELOR, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASHKIHARATEE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, MS, PHD,
Authorized Official - Phone:840-587-4581
Mailing Address - Street 1:24691 STEWART ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2744
Mailing Address - Country:US
Mailing Address - Phone:840-587-4581
Mailing Address - Fax:
Practice Address - Street 1:24691 STEWART ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2744
Practice Address - Country:US
Practice Address - Phone:840-587-4581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)