Provider Demographics
NPI:1922813534
Name:BOTOS, ALYSON DESIREE (MA BCBA)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:DESIREE
Last Name:BOTOS
Suffix:
Gender:F
Credentials:MA BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4297 AMANDA DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-8085
Mailing Address - Country:US
Mailing Address - Phone:720-550-1903
Mailing Address - Fax:
Practice Address - Street 1:5400 W 11TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4623
Practice Address - Country:US
Practice Address - Phone:720-912-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty