Organization
LAUREL GRACE MENTAL HEALTH AND WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LALENCIA L MATTHEWS MSN (CEO)
(612) 388-4661
Entity
Organization
Contact information
Practice address
9614 TRONCAIS CIR, THONOTOSASSA, FL 33592-3412
(612) 388-4661
Mailing address
9614 TRONCAIS CIR, THONOTOSASSA, FL 33592-3412
(612) 388-4661
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/22/2023
Last updated
03/22/2023
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