Healthcare Provider Details

I. General information

NPI: 1689136459
Provider Name (Legal Business Name): NICOLE COLLINS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18899 N THOMPSON PEAK PKWY STE 100
SCOTTSDALE AZ
85255-6335
US

IV. Provider business mailing address

18899 N THOMPSON PEAK PKWY STE 100
SCOTTSDALE AZ
85255-6335
US

V. Phone/Fax

Practice location:
  • Phone: 480-999-6199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-000620
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1981341
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: