Healthcare Provider Details

I. General information

NPI: 1386332823
Provider Name (Legal Business Name): MY TIME 2 LAUNCH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3832 SW 33RD CT
WEST PARK FL
33023-5631
US

IV. Provider business mailing address

3832 SW 33RD CT
WEST PARK FL
33023-5631
US

V. Phone/Fax

Practice location:
  • Phone: 262-707-3257
  • Fax: 954-838-5358
Mailing address:
  • Phone: 262-707-3257
  • Fax: 954-838-5358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. RHONDA J GREENHAW
Title or Position: CHIEF CLINICAL OFFICER
Credential: MA, BCBA 1-11-8196
Phone: 262-707-3257