Provider Demographics
NPI:1942962543
Name:BASTIEN, DER'RESHA KAYLA (LMHC)
Entity Type:Individual
Prefix:MISS
First Name:DER'RESHA
Middle Name:KAYLA
Last Name:BASTIEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 NW 178TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-3480
Mailing Address - Country:US
Mailing Address - Phone:305-917-3256
Mailing Address - Fax:
Practice Address - Street 1:7031 TAFT ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-3864
Practice Address - Country:US
Practice Address - Phone:305-917-3256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLMH23224101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health