| NPI | 1982291365 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA LEE GAIDIS Clinical Psychologist 813-784-7270 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-12-31 |
| Last Update Date | 2020-12-31 |