Provider Demographics
NPI:1245780311
Name:JONES, TORI TARGETT (BCBA)
Entity Type:Individual
Prefix:
First Name:TORI
Middle Name:TARGETT
Last Name:JONES
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5927 STAMFORD ST
Mailing Address - Street 2:
Mailing Address - City:MIMS
Mailing Address - State:FL
Mailing Address - Zip Code:32754-6626
Mailing Address - Country:US
Mailing Address - Phone:321-505-3148
Mailing Address - Fax:
Practice Address - Street 1:5927 STAMFORD ST
Practice Address - Street 2:
Practice Address - City:MIMS
Practice Address - State:FL
Practice Address - Zip Code:32754-6626
Practice Address - Country:US
Practice Address - Phone:321-505-3148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-21-11873106E00000X
171W00000X
FL12363477103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No171W00000XOther Service ProvidersContractor