Provider Demographics
NPI:1164148680
Name:FORRET, NICOLE ELIZBETH I (RBT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ELIZBETH
Last Name:FORRET
Suffix:I
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N WATTERS RD STE 120
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5346
Mailing Address - Country:US
Mailing Address - Phone:469-804-6494
Mailing Address - Fax:
Practice Address - Street 1:800 N WATTERS RD STE 120
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5346
Practice Address - Country:US
Practice Address - Phone:469-804-6494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician