Provider Demographics
NPI:1487902177
Name:BASHAM, MEGAN (LMSW)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:
Last Name:BASHAM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 COUNTY ROAD 284
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-6077
Mailing Address - Country:US
Mailing Address - Phone:512-515-0845
Mailing Address - Fax:512-292-1144
Practice Address - Street 1:2055 COUNTY ROAD 284
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-6077
Practice Address - Country:US
Practice Address - Phone:512-515-0845
Practice Address - Fax:512-292-1144
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56354104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker