| NPI | 1093246589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER L THIBODEAUX Owner 727-610-2395 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY9698) |
| Enumeration Date | 2017-03-25 |
| Last Update Date | 2026-09-08 |