| NPI | 1952764060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BECKY MOREY Office Manager 386-676-5420 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY0003198) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: FL PY0003198) |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: FL PY0003198) | |
| 106H00000X Marriage & Family Therapist (Licence: FL PY0003198) | |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2016-04-05 |