MEDICARE: COURTNEY FOSTER BCABA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106E00000X	Assistant Behavior Analyst	BACB367726

General Provider Information

NPI Number	:	1023471984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY FOSTER BCABA

Provider Business Mailing Address
First Line	:	9536 PRINCETON SQUARE BLVD S
Second Line	:	APT 1512
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-0322
Country	:	US
Telephone Number	:	850-227-5159
Fax Number	:

Provider Business Practice Location Address
First Line	:	3525 US HIGHWAY 17
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-7122
Country	:	US
Telephone Number	:	850-227-5159
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2016
Last Update Date	:	12/10/2020

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Directions to “ COURTNEY FOSTER BCABA” Practice Location

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