Individual
MR. JOHN THOMAS SUPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
938 LAKE BALDWIN LN, ORLANDO, FL 32814-6651
(407) 770-1200
Mailing address
PO BOX 141502, ORLANDO, FL 32814-1502
(407) 770-1201
(407) 898-0858
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
IMT1331
FL
Other
Enumeration date
04/07/2010
Last updated
04/07/2010
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