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General NPI Number Information
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NPI Number | 1487323812
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Entity Type | Organization
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Legal Business Name | ALL STARS ABA LLC
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Dates
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Enumeration Date | 09/09/2021
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 7750 OKEECHOBEE BLVD STE 4-418
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City | WEST PALM BEACH
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State | FL
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Zip | 33411-2104
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Country | US
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Telephone | 845-507-2752
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Fax |
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Provider Business Mailing Address
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Address Line | 3 E EVERGREEN RD
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City | NEW CITY
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State | NY
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Zip | 10956-5101
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Country | US
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Telephone | 845-634-1463
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | JACOB MYTELKA
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Credential |
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Telephone | 561-621-0070
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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 |
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License Number State |
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