Provider Demographics
NPI:1023504586
Name:MCCOY, NIKOLE DONELON (BCBA)
Entity type:Individual
Prefix:MRS
First Name:NIKOLE
Middle Name:DONELON
Last Name:MCCOY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:NIKOLE
Other - Middle Name:MARIE
Other - Last Name:SIMENSMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:4839 PIMENTA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-3520
Mailing Address - Country:US
Mailing Address - Phone:562-688-1487
Mailing Address - Fax:
Practice Address - Street 1:713 W COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1612
Practice Address - Country:US
Practice Address - Phone:714-879-4274
Practice Address - Fax:714-879-2274
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-18-31039103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst