Healthcare Provider Details

I. General information

NPI: 1235936774
Provider Name (Legal Business Name): REACH FOR THE STARS L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 CAPITAL DR
LAKE WORTH FL
33463-8183
US

IV. Provider business mailing address

4640 CAPITAL DR
LAKE WORTH FL
33463-8183
US

V. Phone/Fax

Practice location:
  • Phone: 954-895-9862
  • Fax:
Mailing address:
  • Phone: 954-895-9862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: JESSICA REVORD
Title or Position: OWNER
Credential: BCBA
Phone: 561-934-0624