| NPI | 1184088262 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ANN LANE Sole Mbr 727-417-4491 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: FL SW 3074) |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2016-04-05 |