| NPI | 1417254954 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ELLEN FRAZIER Owner 239-643-9889 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY3803) |
| Enumeration Date | 2011-02-18 |
| Last Update Date | 2011-02-18 |