| NPI | 1073028734 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUDRA WALSH Licensed Psychologist 727-599-3624 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: FL PY9148) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: FL PY9751) |
| Enumeration Date | 2017-12-04 |
| Last Update Date | 2017-12-04 |