Provider Demographics
NPI:1730837535
Name:DR. JESSE BASHEM & ASSOCIATES COMPREHENSIVE PSYCHOLOGICAL SERVICES INC
Entity type:Organization
Organization Name:DR. JESSE BASHEM & ASSOCIATES COMPREHENSIVE PSYCHOLOGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:BASHEM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:949-889-2301
Mailing Address - Street 1:650 FLINN AVE UNIT 6
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2004
Mailing Address - Country:US
Mailing Address - Phone:949-889-2301
Mailing Address - Fax:805-953-8340
Practice Address - Street 1:650 FLINN AVE UNIT 6
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-2004
Practice Address - Country:US
Practice Address - Phone:949-889-2301
Practice Address - Fax:805-953-8340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty