Individual provider Active NPI

Iklas Jarjis Bashi, MA

  • Counselor
  • Detroit, MI
National Provider Identifier
1154478576
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
6401008658 Issued in MI
Practice address
62 W 7 Mile Rd
Detroit, MI 48203-1967
Phone
(313) 893-6172
Fax
(313) 893-0064
NPI assigned
Jan 5, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 6401008658 MI Primary

Addresses

Primary practice location

62 W 7 Mile Rd
Detroit, MI 48203-1967

Mailing address

62 W 7 Mile Rd
Detroit, MI 48203-1967
Phone (313) 893-6172

Other identifiers 1

IdentifierTypeStateIssuer
3434247MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
6401008658MIMDCounselor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1154478576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 W 7 MILE RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482031967",
            "telephone_number": "313-893-6172",
            "fax_number": "313-893-0064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 W 7 MILE RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482031967",
            "telephone_number": "313-893-6172",
            "fax_number": "313-893-0064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASHI",
        "first_name": "IKLAS",
        "middle_name": "JARJIS",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-05",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MI",
            "license": "6401008658",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3434247",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.