| NPI | 1205622388 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY HEIDLER Therapist 239-446-7620 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-04-16 |
| Last Update Date | 2026-06-19 |