=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851109441
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GALAXY BEHAVIOR THERAPY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2024
-----------------------------------------------------
Last Update Date | 05/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 904 LEE BLVD STE 109
-----------------------------------------------------
City | LEHIGH ACRES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33936-4953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-317-0375
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 904 LEE BLVD STE 109
-----------------------------------------------------
City | LEHIGH ACRES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33936-4953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-317-0375
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE DIRECTOR
-----------------------------------------------------
Name | GISSEL CHANG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-317-0375
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376J00000X
-----------------------------------------------------
Taxonomy Name | Homemaker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------