| NPI | 1316456791 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANE ROSE SIMMONS Owner 239-302-7801 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH12440) |
| Additional Taxonomies | 261QM0801X (Licence: FL MH12440) |
| Enumeration Date | 2017-09-28 |
| Last Update Date | 2024-04-09 |