Provider Demographics
NPI:1730458282
Name:BASHAW-CORDELL, ROBIN (MS, PCC-S, CTS)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:BASHAW-CORDELL
Suffix:
Gender:F
Credentials:MS, PCC-S, CTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 383
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-0383
Mailing Address - Country:US
Mailing Address - Phone:937-298-7808
Mailing Address - Fax:
Practice Address - Street 1:3055 RODENBECK DR
Practice Address - Street 2:SUITE 4B
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2699
Practice Address - Country:US
Practice Address - Phone:937-298-7808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0008328101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional