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General NPI Number Information
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NPI Number | 1306116108
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Entity Type | Organization
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Legal Business Name | REACHING THE STARS CENTER FOR AUTISM,INC
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Dates
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Enumeration Date | 01/10/2012
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 5105 HEATHROW BLVD
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City | BRENTWOOD
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State | TN
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Zip | 37027-6538
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Country | US
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Telephone | 818-939-5324
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Fax |
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Provider Business Mailing Address
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Address Line | 4607 LAKEVIEW CANYON RD
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-4028
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Country | US
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Telephone | 818-939-5324
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Fax |
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Authorized Official
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Title or Position | CLINICAL SUPERVISOR
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Name | MR. PATRICK SAMUEL KNIGHT
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Credential | MFT
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Telephone | 818-939-5324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 39923
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License Number State | CA
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