NPI | 1215504055 |
---|---|
Entity Type | Organization |
Authorized Contact | MICHAELENE REESE Credentialing Coordinator 772-489-4726 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
Enumeration Date | 2021-06-09 |
Last Update Date | 2021-06-09 |