Provider Demographics
NPI:1104264696
Name:NIELSEN, LEIF ERIK (CABI)
Entity type:Individual
Prefix:
First Name:LEIF
Middle Name:ERIK
Last Name:NIELSEN
Suffix:
Gender:
Credentials:CABI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1566 WILDRYE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6904
Mailing Address - Country:US
Mailing Address - Phone:775-400-7697
Mailing Address - Fax:
Practice Address - Street 1:2435 PYRAMID WAY STE B
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-1865
Practice Address - Country:US
Practice Address - Phone:775-657-8309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NVCABIT042513103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst