Provider Demographics
NPI:1114392164
Name:MOZIFORT, ANDY (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:MOZIFORT
Suffix:
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 CLEAR CREEK LN
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040-6138
Mailing Address - Country:US
Mailing Address - Phone:772-361-5267
Mailing Address - Fax:
Practice Address - Street 1:2685 PELHAM PKWY STE C
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-1354
Practice Address - Country:US
Practice Address - Phone:205-624-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2023-049103K00000X
FLRBT-18-49564106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician