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NPI Code Detail

MEDICARE: CRYSTAL NICHOLSON-BRAIN MA, BCBA

MEDICARE: CRYSTAL NICHOLSON-BRAIN MA, BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst11314570CA

General Provider Information

NPI Number : 1831506617
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL NICHOLSON-BRAIN MA, BCBA
Provider Business Mailing Address
First Line : 17609 VENTURA BLVD STE 215
Second Line :
City : ENCINO
State : CA
Zip : 91316-5126
Country : US
Telephone Number : 818-501-8352
Fax Number :
Provider Business Practice Location Address
First Line : 100 S ANAHEIM BLVD STE 340
Second Line :
City : ANAHEIM
State : CA
Zip : 92805-3877
Country : US
Telephone Number : 888-428-3223
Fax Number : 323-866-1881
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2014
Last Update Date : 02/07/2020

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Directions to “ CRYSTAL NICHOLSON-BRAIN MA, BCBA” Practice Location

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