Provider Demographics
NPI:1770176588
Name:BICKLER, LAURA E
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:BICKLER
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 1:8407 GLENGARRY PL
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4563
Mailing Address - Country:US
Mailing Address - Phone:727-458-9543
Mailing Address - Fax:
Practice Address - Street 1:8407 GLENGARRY PLACE
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-3465
Practice Address - Country:US
Practice Address - Phone:727-458-9543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MH15841101YM0800X
FLMH15841101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty