Provider Demographics
NPI:1568959765
Name:BAHAM, NATHELDA G
Entity Type:Individual
Prefix:
First Name:NATHELDA
Middle Name:G
Last Name:BAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 W 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-1404
Mailing Address - Country:US
Mailing Address - Phone:985-285-4610
Mailing Address - Fax:
Practice Address - Street 1:19295 N 3RD ST STE 2
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8897
Practice Address - Country:US
Practice Address - Phone:985-400-5901
Practice Address - Fax:985-400-5901
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health