Nicole Leann Householder, RBT

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-21-159268

Practice address

6810 Fort Jackson CT
Milton, FL 32583-7692

Phone

(850) 503-6636

Fax

(850) 626-6132

NPI assigned

Mar 9, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Nicole Leann Devlin Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Lifelong Behavioral Services, LLC

  • Behavior Analyst
  • Milton, FL
  • NPI 1538679832
  NPD (past)

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

{
    "created_epoch": "1615248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615248000000",
    "number": "1962097170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6810 FORT JACKSON CT",
            "city": "MILTON",
            "state": "FL",
            "postal_code": "325837692",
            "telephone_number": "850-503-6636",
            "fax_number": "850-626-6132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6810 FORT JACKSON CT",
            "city": "MILTON",
            "state": "FL",
            "postal_code": "325837692",
            "telephone_number": "850-503-6636",
            "fax_number": "850-626-6132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOUSEHOLDER",
        "first_name": "NICOLE",
        "middle_name": "LEANN",
        "credential": "RBT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-09",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": "RBT-21-159268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "DEVLIN",
            "middle_name": "LEANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• All providers in Milton, FL
• Behavior Technician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2021; 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.