Healthcare Provider Details

I. General information

NPI: 1114661329
Provider Name (Legal Business Name): LAUREN ASHLEY NICHOLS BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2022
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 36TH ST SE
GRAND RAPIDS MI
49548-2355
US

IV. Provider business mailing address

1500 S DOUGLAS RD STE 230
CORAL GABLES FL
33134-4108
US

V. Phone/Fax

Practice location:
  • Phone: 884-854-1116
  • Fax:
Mailing address:
  • Phone: 844-854-1116
  • Fax: 305-846-9711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number7402000268
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: