Active NPI
Krysta Bass, LBA, BCBA
- Behavior Analyst
- Birmingham, AL
National Provider Identifier
1033697248
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 2021-019
- Practice address
- 2305 Arlington Ave S
Birmingham, AL 35205-4111 - Phone
- (205) 957-0294
- Fax
- (205) 957-0298
- NPI assigned
- Jul 31, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 2021-019 | AL | Primary |
Addresses
Primary practice location
2305 Arlington Ave S
Birmingham, AL 35205-4111
Mailing address
4778 Overton Rd
Birmingham, AL 35210-3803
Phone (205) 957-0294
Other practice location 1
4778 Overton Rd
Birmingham, AL 35210-3803
Phone (205) 957-0294
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2021-019 | Other | AL | ALABAMA BEHAVIOR ANALYST LICENSING BOARD |
Other names 1
- Krysta Smith
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2021-019 | AL | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mitchell'S Place, Inc. | Behavior Analyst | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Behavior Analyst
- Birmingham, AL
- NPI 1235263419
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1532995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614902400000",
"number": "1033697248",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4778 OVERTON RD",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352103803",
"telephone_number": "205-957-0294",
"fax_number": "205-957-0298"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2305 ARLINGTON AVE S",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352054111",
"telephone_number": "205-957-0294",
"fax_number": "205-957-0298"
}
],
"practiceLocations": [
{
"address_1": "4778 Overton Rd",
"address_purpose": "LOCATION",
"city": "Birmingham",
"state": "AL",
"postal_code": "352103803",
"country_code": "US",
"telephone_number": "205-957-0294",
"fax_number": "205-957-0298",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BASS",
"first_name": "KRYSTA",
"credential": "LBA, BCBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-31",
"last_updated": "2021-03-05",
"certification_date": "2021-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "AL",
"license": "2021-019",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALABAMA BEHAVIOR ANALYST LICENSING BOARD",
"identifier": "2021-019",
"state": "AL"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KRYSTA",
"last_name": "SMITH",
"credential": "RBT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.