Basic Information
| Provider Information | |||||||||
| NPI: | 1952674657 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BASSHAM | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | HAMILTON | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2777 ROGUE RIVER RD NE | ||||||||
| Address2: | |||||||||
| City: | BELMONT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493069749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9892841429 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1101 BALL AVE NE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495055904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6164566571 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2012 | ||||||||
| LastUpdateDate: | 08/30/2012 | ||||||||
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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 | 1041C0700X | L1998549 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.