Provider Demographics
NPI:1821195215
Name:EICKE, F J (EDD)
Entity Type:Individual
Prefix:DR
First Name:F
Middle Name:J
Last Name:EICKE
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 BIENVILLE BLVD, SUITE 3
Mailing Address - Street 2:P. O. BOX 1877
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39566-1877
Mailing Address - Country:US
Mailing Address - Phone:228-818-3280
Mailing Address - Fax:228-818-3286
Practice Address - Street 1:2902 BIENVILLE BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-4303
Practice Address - Country:US
Practice Address - Phone:228-818-3280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19-206103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0014727Medicaid
MS0014727Medicaid