Provider Demographics
NPI:1689066607
Name:ANDERSON, COURTNEY NICOLE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:NICOLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MISS
Other - First Name:COURTNEY
Other - Middle Name:NICOLE
Other - Last Name:MOSIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCABA
Mailing Address - Street 1:416 WOODLAND PARK CIR
Mailing Address - Street 2:
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-1574
Mailing Address - Country:US
Mailing Address - Phone:407-697-8577
Mailing Address - Fax:
Practice Address - Street 1:416 WOODLAND PARK CIR
Practice Address - Street 2:
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1574
Practice Address - Country:US
Practice Address - Phone:407-697-8577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-13-5515103K00000X
FL1-16-21706103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst