| NPI | 1619653318 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA ANN MOSSFORD-CARROLL CEO 386-316-3004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103K00000X Behavior Analyst | |
| 106E00000X Assistant Behavior Analyst | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2023-06-26 |