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Organization
AG THERAPY CLINIC INC
Active
Organization
AG THERAPY CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YVONNE RODRIGUEZ BS (CHIEF FINANCIAL OFFICER)
(305) 498-9760
Entity
Organization
Contact information
Practice address
2910 CONNER LN, KISSIMMEE, FL 34741-7722
(305) 498-9760
Mailing address
2910 CONNER LN, KISSIMMEE, FL 34741-7722
(305) 498-9760
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
—
—
2084P0800X
Psychiatry Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
09/04/2019
Last updated
12/03/2019
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