Provider Demographics
NPI:1023521853
Name:NICHOLAS, BRYN KATHERINE (BCABA)
Entity type:Individual
Prefix:
First Name:BRYN
Middle Name:KATHERINE
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 E NORTHGATE ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2815
Mailing Address - Country:US
Mailing Address - Phone:317-544-8388
Mailing Address - Fax:317-845-1886
Practice Address - Street 1:2212 E NORTHGATE ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2815
Practice Address - Country:US
Practice Address - Phone:317-544-8388
Practice Address - Fax:317-845-1886
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0-17-8025103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst