Provider Demographics
NPI:1962949867
Name:GALAXY BEHAVIOR THERAPY INC
Entity type:Organization
Organization Name:GALAXY BEHAVIOR THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GISSEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-317-0375
Mailing Address - Street 1:1013 JOEL BLVD
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-3265
Mailing Address - Country:US
Mailing Address - Phone:786-317-0375
Mailing Address - Fax:855-523-1291
Practice Address - Street 1:1013 JOEL BLVD
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-3265
Practice Address - Country:US
Practice Address - Phone:786-317-0375
Practice Address - Fax:855-523-1291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018657300Medicaid
FL108848300Medicaid