| NPI | 1255897849 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE M BOWERS Owner 321-544-1504 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-02-19 |
| Last Update Date | 2019-02-19 |