| NPI | 1942653704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA COLLAZO Office Manager 941-518-1265 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2016-07-18 |