Provider Demographics
NPI:1194357376
Name:SIMS, JACOB (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:SIMS
Suffix:
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9955 TRAMMEL RD
Mailing Address - Street 2:
Mailing Address - City:DORA
Mailing Address - State:AL
Mailing Address - Zip Code:35062-1617
Mailing Address - Country:US
Mailing Address - Phone:205-224-3450
Mailing Address - Fax:
Practice Address - Street 1:614 38TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35222-2414
Practice Address - Country:US
Practice Address - Phone:205-790-1316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRBT-20-111971106S00000X
AL2023-047103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician