| NPI | 1073918546 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN KEITH BOLEN Owner 813-907-0285 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH8545) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL CAP2482) |
| 106H00000X Marriage & Family Therapist (Licence: FL MT2960) | |
| 251S00000X (Licence: FL MH 8545) | |
| Enumeration Date | 2014-10-27 |
| Last Update Date | 2024-03-15 |