| NPI | 1346757531 |
|---|---|
| Former Name | NICOLE LEANNE NELSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 36380) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA RBT-17-38545) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-01-09 |
| Last Update Date | 2026-08-05 |