Provider Demographics
NPI:1083849889
Name:MOREY, NICHOL MARIE (BCBA)
Entity Type:Individual
Prefix:
First Name:NICHOL
Middle Name:MARIE
Last Name:MOREY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4174 EAGLE WATCH WAY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-8034
Mailing Address - Country:US
Mailing Address - Phone:937-572-8916
Mailing Address - Fax:
Practice Address - Street 1:4174 EAGLE WATCH WAY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-8034
Practice Address - Country:US
Practice Address - Phone:937-572-8916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-09-5259103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst