Provider Demographics
NPI:1457580110
Name:BASHUS, SARA R (LCSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:R
Last Name:BASHUS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W MAIN AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-3873
Mailing Address - Country:US
Mailing Address - Phone:701-751-4122
Mailing Address - Fax:701-751-1728
Practice Address - Street 1:107 W MAIN AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3873
Practice Address - Country:US
Practice Address - Phone:701-751-4122
Practice Address - Fax:701-751-1728
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4308104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19270Medicaid