| NPI | 1174198865 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAELENE REESE Credentialing Coordinator 772-489-4726 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2024-11-19 |