MEDICARE: COURTNEY FORD BCBA

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	103K00000X	Behavior Analyst	0-18-30237	CO

General Provider Information

NPI Number	:	1376996033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY FORD BCBA

Provider Business Mailing Address
First Line	:	10256 CLASSIC OAK RD N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-9031
Country	:	US
Telephone Number	:	904-486-8230
Fax Number	:

Provider Business Practice Location Address
First Line	:	619 NE LIMA VIAS
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-6635
Country	:	US
Telephone Number	:	954-559-7987
Fax Number	:

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

Provider Enumeration Date	:	07/18/2016
Last Update Date	:	04/06/2026

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Directions to “ COURTNEY FORD BCBA” Practice Location

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