| NPI | 1104594415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE ALBERTHA MCSHAN Owner/Provider 407-616-1530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty |
| Additional Taxonomies | 261QC1500X Clinic/Center Community Health |
| 261QH0100X Clinic/Center Health Service | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center Adult Mental Health | |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| Enumeration Date | 2021-09-01 |
| Last Update Date | 2022-01-26 |