| NPI | 1003348855 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE PORTER Managing Partner 1386-957-3905 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH6409) |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2017-03-31 |