| NPI | 1861975617 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA SUE KAIN Sole Member 239-398-0337 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY7579) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-09-07 |
| Last Update Date | 2019-01-12 |