Healthcare Provider Details

I. General information

NPI: 1194542126
Provider Name (Legal Business Name): ENVIRONMENTAL THERAPY SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 W BROWARD BLVD STE 203
FT LAUDERDALE FL
33312-1315
US

IV. Provider business mailing address

6230 REESE RD APT 116
DAVIE FL
33314-1269
US

V. Phone/Fax

Practice location:
  • Phone: 305-927-6073
  • Fax:
Mailing address:
  • Phone: 305-927-6073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: FRED MOLINE
Title or Position: CEO
Credential: ARNP
Phone: 305-927-6073