| NPI | 1417467283 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOOHYUN LEE Psychologist 813-972-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X (Licence: MO 2017019227) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: MO 2017019227) |
| 261QV0200X Clinic/Center, VA (Licence: MO 2017019227) | |
| Enumeration Date | 2017-10-06 |
| Last Update Date | 2017-11-17 |