| NPI | 1134276140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHANN NICHOLAS PREWETT Licensed Psychologist 904-269-6071 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY4331) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH6231) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2008-03-24 |