| NPI | 1124491105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP J FAUERBACH President 8813-651-1221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH3399) |
| Enumeration Date | 2015-11-12 |
| Last Update Date | 2015-11-12 |