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NPI Code Detail

MEDICARE: DR. AIMEE BLACKHAM PHD

MEDICARE: DR. AIMEE BLACKHAM PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC1900XCounseling Psychologist1373LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114332038
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AIMEE BLACKHAM PHD
Provider Business Mailing Address
First Line : 2804 LAKEVIEW DR
Second Line :
City : RUSTON
State : LA
Zip : 71270-5254
Country : US
Telephone Number : 318-243-0465
Fax Number :
Provider Business Practice Location Address
First Line : 622 BURGESSVILLE RD
Second Line :
City : RUSTON
State : LA
Zip : 71270-5154
Country : US
Telephone Number : 318-224-7223
Fax Number : 318-414-1004
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2014
Last Update Date : 04/29/2026

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Directions to “ DR. AIMEE BLACKHAM PHD” Practice Location

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