| NPI | 1790065043 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NOLAN HEYWOOD KATZ Vice President 239-247-1756 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 103TS0200X Psychologist, School | |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2019-11-08 |