| NPI | 1306411095 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAELENE REESE Credentialing COO Rdinator 772-489-4726 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2024-11-19 |