| Jasper 1692 Llc | |
|
3015 Country Breeze Dr Plant City FL 33567-8606 | |
| (813) 215-0209 | |
| Not Available |
| Full Name | Jasper 1692 Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 3015 Country Breeze Dr, Plant City, Florida |
| Authorized Official Name and Position | Alison Moore (LCSW) |
| Authorized Official Contact | 8132150209 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jasper 1692 Llc 3015 Country Breeze Dr Plant City FL 33567-8606 Ph: (813) 215-0209 | Jasper 1692 Llc 3015 Country Breeze Dr Plant City FL 33567-8606 Ph: (813) 215-0209 |
| NPI Number | 1386474377 |
|---|---|
| Provider Enumeration Date | 08/05/2024 |
| Last Update Date | 08/05/2024 |
| Certification Date | 08/05/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386474377 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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