| NPI | 1245782176 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY LAHN Owner 954-284-0025 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL mt3051) |
| 103G00000X Clinical Neuropsychologist (Licence: FL py6992) | |
| 103TC0700X Psychologist, Clinical (Licence: FL py6992) | |
| 106H00000X Marriage & Family Therapist (Licence: FL mt2760) | |
| Enumeration Date | 2016-10-26 |
| Last Update Date | 2017-04-24 |