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General NPI Number Information
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NPI Number | 1891281606
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Entity Type | Organization
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Legal Business Name | WHOLEHEARTED INTEGRATIVE BODYMIND THERAPIES LLC
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Dates
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Enumeration Date | 07/04/2018
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 1035 W GLEN OAKS LN STE 204
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City | MEQUON
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State | WI
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Zip | 53092-3395
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Country | US
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Telephone | 414-858-8085
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Fax |
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Provider Business Mailing Address
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Address Line | 661 LAVERNE DR
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City | GREEN BAY
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State | WI
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Zip | 54311-5931
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Country | US
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Telephone | 414-858-8085
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NICOLE L BICKHAM
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Credential | PHD
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Telephone | 414-858-8085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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