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2989 W Sr 434 Ste 100 Longwood FL 32779-4898 | |
| (407) 786-1913 | |
| (407) 960-2636 |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 2989 W Sr 434 Ste 100, Longwood, Florida |
| Authorized Official Name and Position | Peter A. Butkins (DIRECTOR) |
| Authorized Official Contact | 4077186960 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1412 Oak Pl Apt G Apopka FL 32712-1901 Ph: (407) 718-6960 | 2989 W Sr 434 Ste 100 Longwood FL 32779-4898 Ph: (407) 786-1913 |
| NPI Number | 1952808867 |
|---|---|
| Provider Enumeration Date | 04/07/2018 |
| Last Update Date | 04/07/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952808867 | NPI | - | NPPES |
| NPI | Other | FL | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | 000755 (Florida) | Primary |
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