Provider Demographics
NPI:1417429580
Name:DEPRIEST, ANGEL NICOLE (BCBA)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:NICOLE
Last Name:DEPRIEST
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:NICOLE
Other - Last Name:CAMARENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5345 RENO CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2381
Mailing Address - Country:US
Mailing Address - Phone:775-326-9426
Mailing Address - Fax:
Practice Address - Street 1:5345 RENO CORPORATE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2381
Practice Address - Country:US
Practice Address - Phone:775-326-9426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-29
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NVLBA0861103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician