| NPI | 1225780794 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTY SHUTOK Owner 239-287-6624 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2022-01-25 |
| Last Update Date | 2022-02-01 |