| NPI | 1033849575 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LILLIAN INGRAM Owner 813-999-1516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2022-06-16 |
| Last Update Date | 2025-11-07 |