| NPI | 1003053646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT JOHN KENNERLEY Psychologist 386-423-9161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: FL PY6507) |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: FL PY6507) |
| Enumeration Date | 2009-01-20 |
| Last Update Date | 2010-08-26 |