Healthcare Provider Details

I. General information

NPI: 1801675764
Provider Name (Legal Business Name): JOSIE ALLY MIDDLETON BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3351 EASTBROOK DR
FORT COLLINS CO
80525-5745
US

IV. Provider business mailing address

3351 EASTBROOK DR
FORT COLLINS CO
80525-5745
US

V. Phone/Fax

Practice location:
  • Phone: 720-896-7980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89559
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: