Provider Demographics
NPI:1609605567
Name:MARTIN, ALYSON (BCBA)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:MARTIN
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 1:1855 NE LOTUS DR APT 108
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6182
Mailing Address - Country:US
Mailing Address - Phone:860-819-1470
Mailing Address - Fax:
Practice Address - Street 1:1855 NE LOTUS DR APT 108
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6182
Practice Address - Country:US
Practice Address - Phone:860-819-1470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10245741103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst