Active NPI
Conly Elizabeth Basham
- Marriage & Family Therapist
- El Cerrito, CA
National Provider Identifier
1407337850
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- AMFT119075
- Practice address
- 11175 San Pablo Ave
El Cerrito, CA 94530-2157 - Phone
- (510) 559-5550
- NPI assigned
- Aug 23, 2018
- Last updated
- May 22, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | NU | ||
| Marriage & Family Therapist | 106H00000X | AMFT119075 | CA | Primary |
Addresses
Primary practice location
11175 San Pablo Ave
El Cerrito, CA 94530-2157
Mailing address
2178 Ashby Ave Apt C
Berkeley, CA 94705-1836
Phone (501) 920-0671
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AMFT119075 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1590105600000",
"number": "1407337850",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2178 ASHBY AVE APT C",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947051836",
"telephone_number": "501-920-0671"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11175 SAN PABLO AVE",
"city": "EL CERRITO",
"state": "CA",
"postal_code": "945302157",
"telephone_number": "510-559-5550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BASHAM",
"first_name": "CONLY",
"middle_name": "ELIZABETH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-08-23",
"last_updated": "2020-05-22",
"certification_date": "2020-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "AMFT119075",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in El Cerrito, CA
- Oscar Alejandro Barahona Coffin, NP
- Holly Jane Barbarisi, MA MFT
- Charles Jenckes Barnes, M.D.
- Gina Barnes, OTR/L
- Aubrey Ann Fowler Barrett, DMD, MS
- Amita Basra, RN, AYURVEDA
- Bay Area Community Resources, Inc
- Bay Area Community Resources, Inc
- Bay Area Community Resources, Inc (Bay Area Community Resources)
- Shayan Malayeri Bayat, D.D.S.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.