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General NPI Number Information
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NPI Number | 1386332823
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Entity Type | Organization
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Legal Business Name | MY TIME 2 LAUNCH, LLC
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Dates
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Enumeration Date | 04/24/2023
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Last Update Date | 07/25/2023
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Provider Practice Location Address
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Address Line | 3832 SW 33RD CT
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City | WEST PARK
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State | FL
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Zip | 33023-5631
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Country | US
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Telephone | 262-707-3257
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Fax | 954-838-5358
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Provider Business Mailing Address
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Address Line | 3832 SW 33RD CT
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City | WEST PARK
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State | FL
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Zip | 33023-5631
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Country | US
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Telephone | 262-707-3257
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Fax | 954-838-5358
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Authorized Official
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Title or Position | CHIEF CLINICAL OFFICER
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Name | MS. RHONDA J GREENHAW
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Credential | MA, BCBA 1-11-8196
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Telephone | 262-707-3257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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