MEDICARE: MISS NICOLE STIEFLER CLARKSON 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
1	103K00000X	Behavior Analyst	1-11-9667

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1741	OTHER	TX	LICENSED BCBA
2	1-11-9667	OTHER		BCBA

General Provider Information

NPI Number	:	1619270642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS NICOLE STIEFLER CLARKSON BCBA

Provider Business Mailing Address
First Line	:	6319 CYPRESSWOOD DR STE 200
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-8208
Country	:	US
Telephone Number	:	281-798-0302
Fax Number	:	877-602-5087

Provider Business Practice Location Address
First Line	:	6319 CYPRESSWOOD DR STE 200
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-8208
Country	:	US
Telephone Number	:	281-798-0302
Fax Number	:	877-602-5087

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2010
Last Update Date	:	04/01/2025

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