Provider Demographics
NPI:1619270642
Name:CLARKSON, NICOLE STIEFLER (BCBA)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:STIEFLER
Last Name:CLARKSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ALANA
Other - Last Name:STIEFLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:11820 CYPRESS CORNER LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-1132
Mailing Address - Country:US
Mailing Address - Phone:281-894-1423
Mailing Address - Fax:281-894-1422
Practice Address - Street 1:11820 CYPRESS CORNER LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-1132
Practice Address - Country:US
Practice Address - Phone:281-894-1423
Practice Address - Fax:281-894-1422
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-9667103K00000X
0-10-3939103K00000X
TX0-10-3939103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1741OtherLICENSED BCBA
1-11-9667OtherBCBA