Individual
AUSTEN PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11468 WILLOW GARDENS DR, WINDERMERE, FL 34786-6015
(407) 883-1282
Mailing address
11468 WILLOW GARDENS DR, WINDERMERE, FL 34786-6015
(407) 883-1282
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/16/2022
Last updated
08/16/2022
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