| NPI | 1366915944 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY DOUGLAS LAPHAM Director 941-467-2980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2019-01-07 |
| Last Update Date | 2024-09-11 |