| NPI | 1760376529 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERTIE MALLARD-TEAL Owner 813-467-9693 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-06-05 |
| Last Update Date | 2025-06-05 |