| NPI | 1982107462 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNA LIVELY Owner 813-928-5335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: FL MH12213) |
| Enumeration Date | 2018-03-12 |
| Last Update Date | 2018-03-12 |