Active NPI
Kathleen Nicholson
- Behavior Analyst
- Los Angeles, CA
National Provider Identifier
1588100655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 12041860
- Practice address
- 6426 W 5TH St
Los Angeles, CA 90048-4710 - Phone
- (323) 825-7172
- Fax
- (323) 410-1044
- NPI assigned
- Jan 13, 2017
- Last updated
- Oct 14, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | NU | ||
| Behavior Analyst | 103K00000X | 12041860 | CA | Primary |
| Behavior Technician | 106S00000X | 15-06-818 | CA |
Addresses
Primary practice location
6426 W 5TH St
Los Angeles, CA 90048-4710
Mailing address
4215 Mary Ellen Ave
Apt 205
Studio City, CA 91604
Phone (339) 221-8867
Other practice location 1
4215 Mary Ellen Ave
apt 205
Studio City, CA 91604-1823
Phone (339) 221-8867
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12041860 | CA | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jessica Lieber, M.S., Bcba | Behavior Analyst | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1484265600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1665705600000",
"number": "1588100655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4215 MARY ELLEN AVE",
"address_2": "APT 205",
"city": "STUDIO CITY",
"state": "CA",
"postal_code": "91604",
"telephone_number": "339-221-8867"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6426 W 5TH ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900484710",
"telephone_number": "323-825-7172",
"fax_number": "323-410-1044"
}
],
"practiceLocations": [
{
"address_1": "4215 Mary Ellen Ave",
"address_2": "apt 205",
"address_purpose": "LOCATION",
"city": "Studio City",
"state": "CA",
"postal_code": "916041823",
"country_code": "US",
"telephone_number": "339-221-8867",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NICHOLSON",
"first_name": "KATHLEEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-01-13",
"last_updated": "2022-10-14",
"certification_date": "2022-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": "12041860",
"primary": true
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": "15-06-818",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.