| NPI | 1174558373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL ANGELA HERMAN NELSON Clinical Psychologist 772-285-2227 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health (Licence: FL PY7022) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2020-08-22 |