| NPI | 1902554298 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE TALCOTT Partner 904-294-5194 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
| Additional Taxonomies | 103T00000X Psychologist |
| 1041C0700X Social Worker Clinical | |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2022-03-15 |
| Last Update Date | 2022-03-15 |