Healthcare Provider Details

I. General information

NPI: 1720437023
Provider Name (Legal Business Name): KIA TYSON BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 7TH AVE S
BIRMINGHAM AL
35222-3211
US

IV. Provider business mailing address

1859 PRINCETON AVE SW
BIRMINGHAM AL
35211-2427
US

V. Phone/Fax

Practice location:
  • Phone: 205-963-7682
  • Fax:
Mailing address:
  • Phone: 205-233-6833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB311378
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-15-06257
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: