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16 N Clyde Ave Kissimmee FL 34741-5420 | |
| (407) 791-1900 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 16 N Clyde Ave, Kissimmee, Florida |
| Authorized Official Name and Position | Eugenia Ann Wright Agard (CEO) |
| Authorized Official Contact | 4077911900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
16 N Clyde Ave Kissimmee FL 34741-5420 Ph: (407) 791-1900 | 16 N Clyde Ave Kissimmee FL 34741-5420 Ph: (407) 791-1900 |
| NPI Number | 1942655691 |
|---|---|
| Provider Enumeration Date | 05/02/2016 |
| Last Update Date | 05/02/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942655691 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | MH12937 (Florida) | Primary |
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