Healthcare Provider Details

I. General information

NPI: 1003692518
Provider Name (Legal Business Name): NICOLE LEEANN HERBIG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 LEAGUE LINE RD STE 100
CONROE TX
77304-0161
US

IV. Provider business mailing address

1450 LEAGUE LINE RD STE 100
CONROE TX
77304-0161
US

V. Phone/Fax

Practice location:
  • Phone: 908-342-1921
  • Fax:
Mailing address:
  • Phone:
  • 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 Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: