| NPI | 1629548243 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARLENE M. JURON President 941-302-5008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0102203811) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701002059) |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904009017) | |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904004044) | |
| 106H00000X Marriage & Family Therapist (Licence: VA 0717000200) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101262710) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: VA 0101262710) | |
| Enumeration Date | 2018-11-26 |
| Last Update Date | 2018-11-26 |