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General NPI Number Information
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NPI Number | 1336657774
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Entity Type | Individual
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Provider Name | NICOLE RENAE RICKS MS, BCBA
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Gender | Female
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Dates
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Enumeration Date | 01/19/2018
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 378 MT BROSS AVE
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City | SEVERANCE
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State | CO
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Zip | 80550-4862
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Country | US
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Telephone | 171-933-9836
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Fax |
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Provider Business Mailing Address
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Address Line | 3621 MARION LN
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City | LAS CRUCES
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State | NM
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Zip | 88012-7579
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Country | US
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Telephone | 647-828-4133
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Fax | 505-929-6200
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 103550741
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-21-49506
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License Number State | CO
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