Provider Demographics
NPI:1235936774
Name:REACH FOR THE STARS L.L.C
Entity type:Organization
Organization Name:REACH FOR THE STARS L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:REVORD
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:561-934-0624
Mailing Address - Street 1:4640 CAPITAL DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-8183
Mailing Address - Country:US
Mailing Address - Phone:954-895-9862
Mailing Address - Fax:
Practice Address - Street 1:4640 CAPITAL DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-8183
Practice Address - Country:US
Practice Address - Phone:954-895-9862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-03
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty