Individual
NICOLE MARIE NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., BCBA, LBA
Contact information
Practice address
6335 E MAIN ST STE E4, MESA, AZ 85205-8966
(480) 351-7555
Mailing address
6335 E MAIN ST # E4, MESA, AZ 85205-8965
(480) 351-7555
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BEH-000941
AZ
106S00000X
Behavior Technician
RBT-21-181787
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-22-58841
BCBA CERTIFICATE
—
Enumeration date
08/25/2021
Last updated
04/08/2025
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