| NPI | 1356467237 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL HENRY LAKE President 321-632-5155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH8204) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL mh7448) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2020-08-22 |