| NPI | 1003653197 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY A MENTUS Therapist 941-224-4818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YP2500X Counselor Professional | |
| Enumeration Date | 2024-07-15 |
| Last Update Date | 2024-07-15 |