Active NPI
Basshamdbt LLC
- Clinical Social Worker
- Birmingham, MI
National Provider Identifier
1174280002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Legal business name
- BASSHAMDBT LLC
- Practice address
- 200 Elm St Ste 200D
Birmingham, MI 48009-6322 - Phone
- (248) 986-2991
- Fax
- (248) 294-1237
- NPI assigned
- Nov 28, 2021
- Last updated
- Nov 28, 2021
- Organization subpart
- Yes
- Parent organization
- MYMENTALSPACE.ORG
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Kelly Michael Bassham, LMSW
- Title
- Ceo
- Phone
- (248) 986-2991
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | Primary |
Addresses
Primary practice location
200 Elm St Ste 200D
Birmingham, MI 48009-6322
Mailing address
200 Elm St Ste 200D
Birmingham, MI 48009-6322
Phone (248) 986-2991
Other names 1
- mymentalspace.org
National Provider Directory
National Provider Directory- Part of
- Basshamdbt LLC
Locations
200 Elm St
Ste 200D
Birmingham, MI 48009
Phone (248) 986-2991
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Clinical Social Worker
- Birmingham, MI
- NPI 1023363488
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1638057600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1638057600000",
"number": "1174280002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 ELM ST STE 200D",
"city": "BIRMINGHAM",
"state": "MI",
"postal_code": "480096322",
"telephone_number": "248-986-2991",
"fax_number": "248-294-1237"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 ELM ST STE 200D",
"city": "BIRMINGHAM",
"state": "MI",
"postal_code": "480096322",
"telephone_number": "248-986-2991",
"fax_number": "248-294-1237"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BASSHAMDBT LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MYMENTALSPACE.ORG",
"enumeration_date": "2021-11-28",
"last_updated": "2021-11-28",
"certification_date": "2021-11-28",
"status": "A",
"authorized_official_last_name": "BASSHAM",
"authorized_official_first_name": "KELLY",
"authorized_official_middle_name": "MICHAEL",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "248-986-2991",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "LMSW"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "mymentalspace.org",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Birmingham, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.