| NPI | 1962997015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILLIAN GATZ Provider 321-223-7070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT3287) |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2018-06-29 |