Individual
JASON ANDREW MOULD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BCABA
Contact information
Practice address
9815 CROSS PINE CT, LAKE WORTH, FL 33467-2367
(561) 223-8076
(561) 584-5372
Mailing address
9815 CROSS PINE CT, LAKE WORTH, FL 33467-2367
(561) 223-8076
(561) 584-5372
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
0-23-14274
FL
106S00000X
Behavior Technician
RBT-19-108988
FL
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105169200
—
FL
Enumeration date
02/09/2022
Last updated
02/01/2023
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