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NPI Code Detail

MEDICARE: NICOLE ANDERSON MA, BCBA, LBA

MEDICARE: NICOLE ANDERSON MA, BCBA, LBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1222Q00000XDevelopmental Therapist
2103K00000XBehavior AnalystTX

General Provider Information

NPI Number : 1063805869
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE ANDERSON MA, BCBA, LBA
Provider Business Mailing Address
First Line : 2105 E PARK ST
Second Line :
City : CEDAR PARK
State : TX
Zip : 78613-4598
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2105 E PARK ST
Second Line :
City : CEDAR PARK
State : TX
Zip : 78613-4598
Country : US
Telephone Number : 512-986-7335
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2015
Last Update Date : 11/05/2020

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