| NPI | 1851663496 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN RYAN Clinical Director 407-730-3837 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2012-01-28 |
| Last Update Date | 2019-01-24 |