Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | IMT1742 | FL |
NPI | 1003230103 |
---|---|
Provider Name | Bryanna Oswalt |
First Address | Melbourne, FL 32901-3122 |
Second Address | Melbourne, FL 32934-7213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2014 |
Last Update Date | 10/02/2014 |