Provider Demographics
NPI:1881106342
Name:BICKHAM, OMIKA
Entity type:Individual
Prefix:
First Name:OMIKA
Middle Name:
Last Name:BICKHAM
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 1:512 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-4706
Mailing Address - Country:US
Mailing Address - Phone:985-205-0490
Mailing Address - Fax:
Practice Address - Street 1:713 W 6TH ST
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-7042
Practice Address - Country:US
Practice Address - Phone:985-205-0490
Practice Address - Fax:985-205-0490
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst