| NPI | 1295245520 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELLISSA LATOYA JAGRUP Proprieter 813-748-2912 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH9648) |
| Additional Taxonomies | 251S00000X (Licence: FL MH9648) |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: FL MH9648) | |
| Enumeration Date | 2017-09-29 |
| Last Update Date | 2017-09-29 |