Healthcare Provider Details

I. General information

NPI: 1669016606
Provider Name (Legal Business Name): JONALYN NICOLAS BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2019
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 N STEPHANIE ST STE 1514B
HENDERSON NV
89014-8771
US

IV. Provider business mailing address

375 N STEPHANIE ST STE 1514B
HENDERSON NV
89014-8771
US

V. Phone/Fax

Practice location:
  • Phone: 702-550-2791
  • Fax:
Mailing address:
  • Phone: 702-550-2791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA1142
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: