Healthcare Provider Details

I. General information

NPI: 1306349857
Provider Name (Legal Business Name): ANNA ELIZABETH BASHORE LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 E JOLLY RD
LANSING MI
48910-6825
US

IV. Provider business mailing address

4227 WATSON AVE
HOLT MI
48842-1731
US

V. Phone/Fax

Practice location:
  • Phone: 517-237-7350
  • Fax:
Mailing address:
  • Phone: 989-506-2976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberN162770
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801103339
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: