| NPI | 1487660742 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEAH ANNE FENNELL Fellow 813-974-2388 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: FL ME92381) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2020-08-22 |