Healthcare Provider Details

I. General information

NPI: 1073203600
Provider Name (Legal Business Name): TOMORROW'S SUPERHEROES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 COMFORT PL
BILOXI MS
39530-4422
US

IV. Provider business mailing address

133 COMFORT PL
BILOXI MS
39530-4422
US

V. Phone/Fax

Practice location:
  • Phone: 614-282-9895
  • Fax:
Mailing address:
  • Phone: 614-282-9895
  • 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 Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KAYLEY SANGER
Title or Position: OWNER
Credential:
Phone: 614-282-9895