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NPI Code Detail

MEDICARE: MARIAH RACHELLE NICHOLS BCBA

MEDICARE: MARIAH RACHELLE NICHOLS BCBA
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1538947023
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIAH RACHELLE NICHOLS BCBA
Provider Business Mailing Address
First Line : 7563 HIGHWAY 26
Second Line :
City : ROCKHOLDS
State : KY
Zip : 40759-9610
Country : US
Telephone Number : 606-595-8700
Fax Number :
Provider Business Practice Location Address
First Line : 8706 S US HIGHWAY 25
Second Line :
City : CORBIN
State : KY
Zip : 40701-4974
Country : US
Telephone Number : 606-595-8700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2023
Last Update Date : 09/18/2023

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