Healthcare Provider Details

I. General information

NPI: 1194357376
Provider Name (Legal Business Name): JACOB SIMS BCBA, LBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 38TH ST S
BIRMINGHAM AL
35222-2414
US

IV. Provider business mailing address

9955 TRAMMEL RD
DORA AL
35062-1617
US

V. Phone/Fax

Practice location:
  • Phone: 205-790-1316
  • Fax:
Mailing address:
  • Phone: 205-224-3450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2023-047
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-111971
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: