Provider Demographics
NPI:1497513709
Name:LAWSON, NICHOLAS (MS, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:LAWSON
Suffix:
Gender:M
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16601 N 75TH AVE UNIT 2038
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-5006
Mailing Address - Country:US
Mailing Address - Phone:636-317-7196
Mailing Address - Fax:
Practice Address - Street 1:5621 W BEVERLY LN
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-1879
Practice Address - Country:US
Practice Address - Phone:623-400-6711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-001247103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst