Provider Demographics
NPI:1194542126
Name:ENVIRONMENTAL THERAPY SOLUTIONS LLC
Entity type:Organization
Organization Name:ENVIRONMENTAL THERAPY SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:305-927-6073
Mailing Address - Street 1:6230 REESE RD APT 116
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-1269
Mailing Address - Country:US
Mailing Address - Phone:305-927-6073
Mailing Address - Fax:
Practice Address - Street 1:2630 W BROWARD BLVD STE 203
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-1315
Practice Address - Country:US
Practice Address - Phone:305-927-6073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty