Provider Demographics
NPI:1376015743
Name:DOSS, JACOB (BCBA, LBA)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:
Last Name:DOSS
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 1:164 STRICKLIN RD
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35057-3305
Mailing Address - Country:US
Mailing Address - Phone:256-469-8493
Mailing Address - Fax:
Practice Address - Street 1:164 STRICKLIN RD
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35057-3305
Practice Address - Country:US
Practice Address - Phone:256-469-8493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
AL2019-015103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst