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Individual

MRS. NICOLE SHANNON HERRERA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
BCABA

Contact information

Practice address
8319 NEWBURY WAY, FOUNTAIN, CO 80817-4049
(850) 630-3358
Mailing address
8319 NEWBURY WAY, FOUNTAIN, CO 80817-4049
(850) 630-3358

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0-11-4012
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0-11-4012
BCABA CERIFICATION NUMBER (BOARD CERTIFIED ASSISTANT BEHAVIOR ANALYST)
CO
Enumeration date
04/11/2011
Last updated
04/11/2011
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