Basic Information
| Provider Information | |||||||||
| NPI: | 1538713540 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALHASHEM | ||||||||
| FirstName: | HUSSAIN | ||||||||
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| Credential: | PLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 COMMUNITY | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 647358804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8884031071 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1780 OLD HIGHWAY 50 E STE 102 | ||||||||
| Address2: | |||||||||
| City: | UNION | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630843397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8884031071 | ||||||||
| FaxNumber: | 6365832885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2019 | ||||||||
| LastUpdateDate: | 07/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TB0200X | 2019029068 | MO | Y | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral |
No ID Information.