Healthcare Provider Details

I. General information

NPI: 1376996033
Provider Name (Legal Business Name): COURTNEY FORD BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 NE LIMA VIAS
JENSEN BEACH FL
34957-6635
US

IV. Provider business mailing address

10256 CLASSIC OAK RD N
JACKSONVILLE FL
32225-9031
US

V. Phone/Fax

Practice location:
  • Phone: 954-559-7987
  • Fax:
Mailing address:
  • Phone: 904-486-8230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0-18-30237
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: