| Wholehearted Integrative Bodymind Therapies Llc | |
|
416 George St Ste 108 De Pere WI 54115-2773 | |
| (414) 858-8085 | |
| Not Available |
| Full Name | Wholehearted Integrative Bodymind Therapies Llc |
|---|---|
| Speciality | Psychologist |
| Location | 416 George St Ste 108, De Pere, Wisconsin |
| Authorized Official Name and Position | Nicole L Bickham (OWNER) |
| Authorized Official Contact | 4148588085 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wholehearted Integrative Bodymind Therapies Llc 4014 N Stowell Ave Shorewood WI 53211-2132 Ph: (414) 858-8085 | Wholehearted Integrative Bodymind Therapies Llc 416 George St Ste 108 De Pere WI 54115-2773 Ph: (414) 858-8085 |
| NPI Number | 1891281606 |
|---|---|
| Provider Enumeration Date | 07/04/2018 |
| Last Update Date | 07/04/2018 |
| Medicare PECOS PAC ID | 4880933647 |
|---|---|
| Medicare Enrollment ID | O20190222001781 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891281606 | NPI | - | NPPES |
| 100072756 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Nicole L Bickham |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1134666514 PECOS PAC ID: 6800130261 Enrollment ID: I20181212000892 |
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