NPI | 1417183419 |
---|---|
Entity Type | Organization |
Authorized Contact | JOHN R. THIBODEAU Sole Member 321-972-5693 |
Organization Subpart ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY 7684) |
Enumeration Date | 2009-06-04 |
Last Update Date | 2009-06-04 |