Provider Demographics
NPI:1780381483
Name:ROOS, NICHOLAS EDWARD (RBT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:EDWARD
Last Name:ROOS
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 W LAMBERTH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-5181
Mailing Address - Country:US
Mailing Address - Phone:254-249-6530
Mailing Address - Fax:
Practice Address - Street 1:2612 W LAMBERTH RD STE 100
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-5181
Practice Address - Country:US
Practice Address - Phone:254-249-6530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2025-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician