Provider Demographics
NPI:1710223466
Name:ONSTAD, NICOLE JANISE (BCBA 1-04-1919)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:JANISE
Last Name:ONSTAD
Suffix:
Gender:F
Credentials:BCBA 1-04-1919
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28241 CROWN VALLEY PKWY
Mailing Address - Street 2:F625
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4441
Mailing Address - Country:US
Mailing Address - Phone:949-310-5517
Mailing Address - Fax:949-297-4310
Practice Address - Street 1:28241 CROWN VALLEY PKWY
Practice Address - Street 2:F625
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-4441
Practice Address - Country:US
Practice Address - Phone:949-310-5517
Practice Address - Fax:949-297-4310
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-04-1919103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst