Provider Demographics
NPI:1336698612
Name:ACKER, NICHOLAS (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:ACKER
Suffix:
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-0129
Mailing Address - Country:US
Mailing Address - Phone:269-953-7468
Mailing Address - Fax:
Practice Address - Street 1:419 W COLFAX ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1103
Practice Address - Country:US
Practice Address - Phone:269-331-6022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
MI7401000952103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1715928Medicaid