| NPI | 1982149696 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUBY P ITZEN Lmhc 239-410-0065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL MH 7536) |
| Enumeration Date | 2017-01-04 |
| Last Update Date | 2017-01-04 |