Healthcare Provider Details

I. General information

NPI: 1003092255
Provider Name (Legal Business Name): CHRISTINA MARIE NULK M.S., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2008
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6050 ERIN PARK DR
COLORADO SPRINGS CO
80918-3488
US

IV. Provider business mailing address

PO BOX 13695
FT CARSON CO
80902-0695
US

V. Phone/Fax

Practice location:
  • Phone: 719-465-3989
  • Fax: 719-375-8499
Mailing address:
  • Phone: 719-271-9975
  • Fax: 719-404-4126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0384258
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: