| NPI | 1073092722 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE LYON Owner 321-430-5966 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2020-03-18 |