| NPI | 1306002803 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHYLLIS K. JENSEN Psychologist 941-485-0854 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL PY6912) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2009-05-27 |