| NPI | 1346502069 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN LEE ZIMMERMAN Owner 407-580-6997 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL MH 9575) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: CO PSYCHOLOGIST 2721) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2012-06-08 |