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Organization
JASPER 1692 LLC
Active
Organization
JASPER 1692 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALISON MOORE (LCSW)
(813) 215-0209
Entity
Organization
Contact information
Practice address
3015 COUNTRY BREEZE DR, PLANT CITY, FL 33567-8606
(813) 215-0209
Mailing address
3015 COUNTRY BREEZE DR, PLANT CITY, FL 33567-8606
(813) 215-0209
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
08/05/2024
Last updated
08/05/2024
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