Healthcare Provider Details

I. General information

NPI: 1528709656
Provider Name (Legal Business Name): THE NURTURE NATURE CONNECTION, COMPASSIONATE APPLIED BEHAVIOR ANALYSIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N CASCADE AVE
COLORADO SPRINGS CO
80903-3308
US

IV. Provider business mailing address

2008 E JACKSON ST APT 10
COLORADO SPRINGS CO
80909-1842
US

V. Phone/Fax

Practice location:
  • Phone: 719-413-0336
  • Fax:
Mailing address:
  • Phone: 720-201-1771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. KELLY RENE' INGLISA
Title or Position: EXECUTIVE DIRECTOR
Credential: BCBA
Phone: 720-201-1771