Individual provider · Type 1 NPI

Shane Bastar, SAC-IT

Addiction (Substance Use Disorder) Counselor · Green Bay, WI

NPI number 1457044000 Active

Practice location

2357 W Mason St
Green Bay, WI 54303-4708

Call (920) 337-6740 Map

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400X20212-130 (WI)

Addiction (Substance Use Disorder) Counselor: Definition to come...

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About NPI 1457044000

Shane Bastar, SAC-IT's National Provider Identifier is 1457044000, issued on May 31, 2023. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Green Bay, WI. The record was last updated on May 31, 2023.