| NPI | 1619114972 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIA AILEEN KERN-BUTLER Owner/President 863-402-9182 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY6186) |
| Enumeration Date | 2009-01-08 |
| Last Update Date | 2009-10-14 |