Provider Demographics
NPI:1811138977
Name:BUSICK, MATTHEW DOUGLAS (PHD, BCBA, LBA)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DOUGLAS
Last Name:BUSICK
Suffix:
Gender:M
Credentials:PHD, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5636 6TH CT S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35212-3734
Mailing Address - Country:US
Mailing Address - Phone:205-718-9519
Mailing Address - Fax:
Practice Address - Street 1:2233 CAHABA VALLEY DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-2602
Practice Address - Country:US
Practice Address - Phone:205-718-9519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2017-141103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-06-3188OtherBCBA CERTIFICATION #
12315497OtherCAQH PROFILE #
AL2017-141OtherALABAMA LICENSED BEHAVIOR ANALYST