Jena Suzanne Nickerson, BCBA LBA-TX

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

5504 Issued in TX

Practice address

1100 Circle Dr Ste 101
Fort Worth, TX 76119-8111

Phone

(817) 566-1100

NPI assigned

Jan 4, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Autistic Treatment Center, Inc.

  • Behavior Analyst
  • Fort Worth, TX
  • NPI 1184367708
  NPD
• Autistic Treatment Center Inc

  • Rehabilitation Clinic/Center
  • Fort Worth, TX
  • NPI 1932455284
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1672790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672790400000",
    "number": "1154034106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 CIRCLE DR STE 101",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761198111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 CIRCLE DR STE 101",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761198111",
            "telephone_number": "817-566-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKERSON",
        "first_name": "JENA",
        "middle_name": "SUZANNE",
        "credential": "BCBA LBA-TX",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-01-04",
        "last_updated": "2023-01-04",
        "certification_date": "2023-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": "TX",
            "license": "5504",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "8175661100",
            "affiliation": "Y",
            "endpointDescription": "Office Line",
            "affiliationName": "Autistic Treatment Center, Inc.",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1100 Circle Dr Ste 101",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761198111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Monique Brown Nicholson, R.PH
• Paulina Nicholson, LPC
• Ramona Nicholson
• Nick Le DDS PLLC
• Christine Ragnauth Nickerson, MA, LPC
• Toyree Nickerson
• Vicki Nicklas, PT
• Alford Frederick Nicol
• Nancy Carolina Nicoloso, NP-C
• Derek Nieber, M.D.

• Behavior Analyst in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Behavior Analyst in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.