| NPI | 1891346805 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONNIE MCCULLOUGH President 813-956-6817 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YS0200X Counselor School |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) | |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| 103TE1100X Psychologist Exercise & Sports | |
| Enumeration Date | 2019-09-23 |
| Last Update Date | 2019-09-23 |