Healthcare Provider Details

I. General information

NPI: 1467878736
Provider Name (Legal Business Name): NICOLE MATHIAS B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 KRESGE LN
SPARKS NV
89431-6435
US

IV. Provider business mailing address

350 KRESGE LN
SPARKS NV
89431-6435
US

V. Phone/Fax

Practice location:
  • Phone: 775-359-9200
  • Fax: 775-359-9205
Mailing address:
  • Phone: 775-359-9200
  • Fax: 775-359-9205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: