Provider Demographics
NPI:1376705400
Name:BANK, NICOLE LYNN (MS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LYNN
Last Name:BANK
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3578 HARTSEL DR
Mailing Address - Street 2:UNIT E-200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-2103
Mailing Address - Country:US
Mailing Address - Phone:719-271-1525
Mailing Address - Fax:719-260-6667
Practice Address - Street 1:3578 HARTSEL DR
Practice Address - Street 2:UNIT E-200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-2103
Practice Address - Country:US
Practice Address - Phone:719-271-1525
Practice Address - Fax:719-260-6667
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-05-2127103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst