Provider Demographics
NPI:1801306352
Name:MIMS, ALYSON CAROLINE (BCBA)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:CAROLINE
Last Name:MIMS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:CAROLINE
Other - Last Name:BOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 EASTON GLEN LN
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-5395
Mailing Address - Country:US
Mailing Address - Phone:832-995-7478
Mailing Address - Fax:
Practice Address - Street 1:1332 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-6306
Practice Address - Country:US
Practice Address - Phone:713-355-0623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-18-29420103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst