| NPI | 1194360164 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLIOTT RICHELSON Chief Medical Officer 941-444-1730 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2019-11-13 |
| Last Update Date | 2022-05-03 |