Provider Demographics
NPI:1962540013
Name:BHASME, BENJAMIN A (MA, LPC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:A
Last Name:BHASME
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12825 FLUSHING MEADOWS DR
Mailing Address - Street 2:SUITE 270
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1837
Mailing Address - Country:US
Mailing Address - Phone:314-909-7775
Mailing Address - Fax:314-821-7548
Practice Address - Street 1:12825 FLUSHING MEADOWS DR
Practice Address - Street 2:SUITE 270
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1837
Practice Address - Country:US
Practice Address - Phone:314-909-7775
Practice Address - Fax:314-821-7548
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002032299101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional