| NPI | 1093065435 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE LEE BANCROFT Clinical Director 239-262-0515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT2329) |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2013-08-22 |