| NPI | 1053028787 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARA TRIDLE Owner 941-780-4268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-11-02 |
| Last Update Date | 2022-11-17 |