| NPI | 1063772689 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE TULL Administrator 863-937-9152 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH4263) |
| Enumeration Date | 2012-05-17 |
| Last Update Date | 2012-05-17 |