| NPI | 1194128066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ETHAN MARTIN Licensed Mental Health Counselor 239-849-6813 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL 12248) |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2014-10-06 |