| NPI | 1578077335 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN MERTENS Owner/President 321-677-2789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY10004) |
| Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: FL PY10004) |
| 103TH0004X Psychologist, Health (Licence: CT 002722) | |
| 103TC0700X Psychologist, Clinical (Licence: CT 002722) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: FL PY10004) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: CT 002722) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: FL PY10004) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CT 002722) | |
| Enumeration Date | 2017-11-30 |
| Last Update Date | 2017-11-30 |