| NPI | 1023601986 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TALISSA LECINUE COX Registered Behavior Technician 813-557-9128 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2021-02-11 |
| Last Update Date | 2021-02-11 |