Organization
FAMILY PRESERVATION SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERARD SPRAGUE LMHC (CMH SUPERVISOR)
(239) 332-8009
Entity
Organization
Contact information
Practice address
2180 MARAVILLA LN, FORT MYERS, FL 33901-7221
(239) 332-8009
Mailing address
2180 MARAVILLA LN, FORT MYERS, FL 33901-7221
(239) 332-8009
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
FL
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063528560
FPS NPI
FL
Enumeration date
11/01/2011
Last updated
11/01/2011
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