Provider Demographics
NPI:1366483067
Name:BASHIR, RAHILA AMJAD (LMHC)
Entity type:Individual
Prefix:MS
First Name:RAHILA
Middle Name:AMJAD
Last Name:BASHIR
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:RAHILA
Other - Middle Name:
Other - Last Name:BASHIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:1338 PORT MALABAR BLVD NE
Mailing Address - Street 2:10
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-5259
Mailing Address - Country:US
Mailing Address - Phone:321-720-1709
Mailing Address - Fax:321-733-1860
Practice Address - Street 1:4650 LIPSCOMB ST NE STE 10
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-2997
Practice Address - Country:US
Practice Address - Phone:321-720-1709
Practice Address - Fax:321-720-1709
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7753101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1366483067OtherNPI