| NPI | 1063054310 |
|---|---|
| Other Name | PSYCHOLOGIST OFFICE |
| Entity Type | Organization |
| Authorized Contact | NICKEISHA K CLARKE Provider 813-445-8575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| Enumeration Date | 2019-10-08 |
| Last Update Date | 2019-11-08 |