Provider Demographics
NPI:1942717715
Name:BURGOS MCCOLLUM, KIMBERLY M (BCBA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:BURGOS MCCOLLUM
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 7TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35222-3211
Mailing Address - Country:US
Mailing Address - Phone:205-490-8228
Mailing Address - Fax:205-957-0298
Practice Address - Street 1:3500 7TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35222-3211
Practice Address - Country:US
Practice Address - Phone:205-490-8228
Practice Address - Fax:205-957-0298
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
AL2021-080103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician