| NPI | 1679161491 |
|---|---|
| Doing Business As | PHYLLIS WALTERS, PH.D. |
| Entity Type | Organization |
| Authorized Contact | MARCO BIANCHI Billing Manager 239-297-1508 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2021-01-07 |