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General NPI Number Information
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NPI Number | 1679355473
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Entity Type | Individual
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Provider Name | JAMES ST FORT
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Gender | Male
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Dates
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Enumeration Date | 10/17/2023
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | CULTIVATE BEHAVIORAL HEALTH AND EDUCATION 9970 S. CENTRAL PARK BOULEVARD. SUITE 401.
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City | BOCA RATON
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State | FL
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Zip | 33428
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Country | US
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Telephone | 305-807-1909
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Fax |
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Provider Business Mailing Address
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Address Line | 1820 NW 2ND TER
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City | POMPANO BEACH
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State | FL
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Zip | 33060-5019
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Country | US
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Telephone | 175-423-5800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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