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 |