| NPI | 1164080784 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMERLYN JOHNSON Operations Adminstrator 813-422-5502 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2020-04-22 |