Basic Information
| Provider Information | |||||||||
| NPI: | 1306233226 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REETZ | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | KYLE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2609 MEDARY AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432022684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152126103 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2540 BILLINGSLEY RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432351990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144702018 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2015 | ||||||||
| LastUpdateDate: | 01/16/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-13-14618 | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 103K00000X | COBA.00483 | OH | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.