| NPI | 1871956805 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEFANIE COPPES Owner 800-687-1938 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: FL PY8604) |
| 103TC0700X Psychologist Clinical (Licence: FL PY8604) | |
| 103TC1900X Psychologist Counseling (Licence: FL PY8604) | |
| 103TE1100X Psychologist Exercise & Sports (Licence: FL PY8604) | |
| 103TF0000X Psychologist Family (Licence: FL PY8604) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: FL PY8604) | |
| 103TS0200X Psychologist School (Licence: FL PY8604) | |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2022-07-05 |