Provider Demographics
NPI:1194999615
Name:BICHELMAN, NICOLE MARIE (MA, BCBA)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:BICHELMAN
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:862 WINTERFIELDS DR.
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-7965
Mailing Address - Country:US
Mailing Address - Phone:901-240-4157
Mailing Address - Fax:866-545-3390
Practice Address - Street 1:862 WINTERFIELDS DR.
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-7965
Practice Address - Country:US
Practice Address - Phone:901-240-4157
Practice Address - Fax:866-545-3390
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF78Medicaid