Provider Demographics
NPI:1083199079
Name:KING, COURTLAND U (RBT)
Entity Type:Individual
Prefix:
First Name:COURTLAND
Middle Name:U
Last Name:KING
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6262 WAUCONDA WAY W
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-5870
Mailing Address - Country:US
Mailing Address - Phone:561-713-6920
Mailing Address - Fax:
Practice Address - Street 1:6262 WAUCONDA WAY W
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-5870
Practice Address - Country:US
Practice Address - Phone:561-713-6920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-65156247200000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other