| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1614 Palm Way, Largo, Florida |
| Authorized Official Name and Position | Jo M Watson (BILLING SPECIALIST) |
| Authorized Official Contact | 7275456477 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1614 Palm Way Largo FL 33771-3926 Ph: (727) 545-6477 | 1614 Palm Way Largo FL 33771-3926 Ph: (727) 545-6477 |
| NPI Number | 1083779375 |
|---|---|
| Provider Enumeration Date | 12/27/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083779375 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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