| NPI | 1477047546 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTAL ORTIZ Credentialing Manager 239-980-4988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 163WP0808X Registered Nurse, Psych/Mental Health | |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2025-08-08 |