| NPI | 1962989806 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOLENE DE LA GARDELLE VP Operations 813-277-4571 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 103T00000X Psychologist |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry | |
| 251S00000X | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2024-09-04 |