| NPI | 1770834160 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEAN MULLOY Clinical Director 813-877-1111 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL py5467) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL lmt1692) |
| Enumeration Date | 2012-09-25 |
| Last Update Date | 2012-09-25 |