| NPI | 1124915061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTEN COX Owner 863-660-5654 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-06-23 |
| Last Update Date | 2025-09-19 |