Basic Information
| Provider Information | |||||||||
| NPI: | 1164809422 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOUCK | ||||||||
| FirstName: | NICOLAS | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1321 MURFREESBORO PIKE STE 702 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372172679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153614000 | ||||||||
| FaxNumber: | 6158151946 | ||||||||
| Practice Location | |||||||||
| Address1: | 1081 THORNBERRY DR | ||||||||
| Address2: | |||||||||
| City: | MADISONVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424311672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708541480 | ||||||||
| FaxNumber: | 6158151946 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2015 | ||||||||
| LastUpdateDate: | 07/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 0-15-6481 | FL | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 103K00000X | 240843 | KY | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 1-16-21378 | 01 | BCBA CERTIFICATION | OTHER |