| NPI | 1629731492 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHEMECH PATTERSON Owner 904-735-8319 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 251S00000X |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| Enumeration Date | 2021-10-19 |
| Last Update Date | 2021-10-28 |