Individual
MRS. NICOLE RENAE RICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, BCBA
Contact information
Practice address
378 MT BROSS AVE, SEVERANCE, CO 80550-4862
(171) 933-9836
Mailing address
3621 MARION LN, LAS CRUCES, NM 88012-7579
(647) 828-4133
(505) 929-6200
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-49506
CO
106S00000X
Behavior Technician
103550741
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21782369
—
CO
Enumeration date
01/19/2018
Last updated
06/08/2023
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