Doctor Name: | AIMEE BLACKHAM |
NPI Number: | 1114332038 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD |
License Number: | 273865 |
Business Practice Address: | 617 S Trenton St Ruston, LA - 712705040 |
Business Phone Number: | 3182514659 |
Business Fax Number: | 3182514659 |
Mailing Address: | 617 S Trenton St, RUSTON |
State: | LA |
Postal Code: | 712705040 |
Phone Number: | 3182514659 |
Fax Number: | 3182514659 |
NPI Enumeration Date: | 06/30/2014 |
NPI Last Update Date: | 06/30/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 273865 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |