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General NPI Number Information
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NPI Number | 1700289816
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Entity Type | Individual
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Provider Name | LORI MARIE NICE M.S., BCBA
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Gender | Female
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Dates
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Enumeration Date | 10/02/2014
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Last Update Date | 09/11/2018
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Provider Practice Location Address
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Address Line | 3425 COFFEE RD
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City | MODESTO
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State | CA
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Zip | 95355
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Country | US
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Telephone | 209-521-4791
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Fax | 209-521-4794
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Provider Business Mailing Address
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Address Line | 3425 COFFEE RD
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City | MODESTO
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State | CA
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Zip | 95355-1582
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Country | US
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Telephone | 209-521-4791
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Fax | 209-521-4794
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 80-0000791
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License Number State | CA
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