| NPI | 1376320531 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY D REYNOLDS Owner 352-777-9887 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2023-09-12 |
| Last Update Date | 2023-09-12 |