Provider Demographics
NPI:1891202461
Name:NICHOLS, KACEY PRESTON (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:KACEY
Middle Name:PRESTON
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 PARK MARINA DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0962
Mailing Address - Country:US
Mailing Address - Phone:530-232-0845
Mailing Address - Fax:
Practice Address - Street 1:1907 PARK MARINA DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0962
Practice Address - Country:US
Practice Address - Phone:530-232-0845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-17-28479103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst