Healthcare Provider Details

I. General information

NPI: 1922447572
Provider Name (Legal Business Name): NELL ELIZABETH NICHOLS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS DANIELLE ELIZABETH SHETTER

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2584 R W JOHNSON BLVD SW STE 100
TUMWATER WA
98512-6103
US

IV. Provider business mailing address

3231 WILLAMETTE DR NE STE A
LACEY WA
98516-1378
US

V. Phone/Fax

Practice location:
  • Phone: 360-878-6434
  • Fax: 844-452-1758
Mailing address:
  • Phone: 360-878-6434
  • Fax: 844-452-1758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberAB61124821
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA61259363
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCBT.CB.60846528
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: