Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 103K00000X | Behavior Analyst | ||
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1467878736 |
---|---|
Provider Name | Nicole Mathias |
First Address | Sparks, NV 89431-6435 |
Second Address | Sparks, NV 89431-6435 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2014 |
Last Update Date | 11/03/2014 |