| NPI | 1578304465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINA ILCZYSZYN Credentialing 239-690-6906 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 103TC0700X Psychologist, Clinical | |
| 104100000X Social Worker | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2024-06-04 |
| Last Update Date | 2024-06-04 |