Provider Demographics
NPI:1922786458
Name:WYRICK, NOHELY (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:NOHELY
Middle Name:
Last Name:WYRICK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 TANSEL RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-1648
Mailing Address - Country:US
Mailing Address - Phone:317-730-2133
Mailing Address - Fax:
Practice Address - Street 1:321 E NORTHFIELD DR
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-2420
Practice Address - Country:US
Practice Address - Phone:317-742-9025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-23-65803103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst