| NPI | 1235184920 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELAINE BANTA President 561-427-0144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY4354FL) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC NC1669NC) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2011-12-05 |