MEDICARE: DR. MATTHEW DOUGLAS BUSICK PHD, BCBA, LBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	2017-141	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-06-3188	OTHER		BCBA CERTIFICATION #
2	12315497	OTHER		CAQH PROFILE #
3	2017-141	OTHER	AL	ALABAMA LICENSED BEHAVIOR ANALYST

General Provider Information

NPI Number	:	1811138977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW DOUGLAS BUSICK PHD, BCBA, LBA

Provider Business Mailing Address
First Line	:	5636 6TH CT S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35212-3734
Country	:	US
Telephone Number	:	205-718-9519
Fax Number	:

Provider Business Practice Location Address
First Line	:	2233 CAHABA VALLEY DR
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-2602
Country	:	US
Telephone Number	:	205-718-9519
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2009
Last Update Date	:	11/05/2020

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