| NPI | 1467792697 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAKE BAZEL Psychologist 904-272-0043 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY 8593) |
| Enumeration Date | 2013-02-25 |
| Last Update Date | 2013-04-23 |