Individual
MS. NICOLE L THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
8350 CRAIG ST, INDIANAPOLIS, IN 46250-3593
(317) 578-0410
Mailing address
7627 ISLAND CLUB DR, INDIANAPOLIS, IN 46214-4159
(219) 718-1909
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-18-33768
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
96151
—
IN
01
—
97155
MHS
IN
01
—
H0032
UMR
IN
Enumeration date
01/21/2019
Last updated
01/21/2019
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