| NPI | 1508617556 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI ELLEN MARTINEZ Psychotherapist 239-961-0284 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2024-03-28 |
| Last Update Date | 2024-06-05 |