Healthcare Provider Details

I. General information

NPI: 1033040142
Provider Name (Legal Business Name): JONATHAN STEVEN BASHLINE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5607 MOUNT MURPHY RD
GARDEN VALLEY CA
95633
US

IV. Provider business mailing address

PO BOX 871
GARDEN VALLEY CA
95633-0871
US

V. Phone/Fax

Practice location:
  • Phone: 530-333-9460
  • Fax: 530-748-4077
Mailing address:
  • Phone: 530-333-9460
  • Fax: 530-748-4077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: