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General NPI Number Information
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NPI Number | 1750855912
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Entity Type | Individual
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Provider Name | NICOLE L THOMAS BCBA
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Gender | Female
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Dates
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Enumeration Date | 01/21/2019
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Last Update Date | 01/21/2019
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Provider Practice Location Address
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Address Line | 8350 CRAIG ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-3593
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Country | US
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Telephone | 317-578-0410
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Fax |
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Provider Business Mailing Address
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Address Line | 7627 ISLAND CLUB DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46214-4159
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Country | US
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Telephone | 219-718-1909
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Fax |
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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 | 1-18-33768
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License Number State | IN
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