Provider Demographics
NPI:1316676760
Name:ALFORD, MATT (MS, BCBA)
Entity type:Individual
Prefix:
First Name:MATT
Middle Name:
Last Name:ALFORD
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 TWIN OAK DR
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-9383
Mailing Address - Country:US
Mailing Address - Phone:850-398-7809
Mailing Address - Fax:
Practice Address - Street 1:122 TWIN OAK DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-9383
Practice Address - Country:US
Practice Address - Phone:850-398-7809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-19-35601103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst