NPI 1497304398 · live from the CMS NPI Registry
Ag Therapy Clinic INC
Clinic/Center, Mental Health (Including Community Mental Health Center) in Kissimmee, FL. National Provider Identifier 1497304398, active.
NPI record
| NPI | 1497304398 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Clinic/Center, Mental Health (Including Community Mental Health Center) 261QM0801X |
| Practice location | 2910 Conner Ln, Kissimmee, FL 34741 |
| Practice phone | 305-498-9760 |
| Enumerated | September 4, 2019 |
| Last updated | December 3, 2019 |
| Authorized official | Yvonne Rodriguez, Chief Financial Officer |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Behavior Analyst | 103K00000X | — |
| Counselor, Mental Health | 101YM0800X | — |
| Psychiatry & Neurology, Psychiatry | 2084P0800X | — |
| Clinic/Center, Mental Health (Including Community Mental Health Center) primary | 261QM0801X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.