Healthcare Provider Details

I. General information

NPI: 1114988607
Provider Name (Legal Business Name): T BOLAND ARNP LMFT PHDC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 SW 148TH AVE STE 130
SUNRISE FL
33325
US

IV. Provider business mailing address

1112 WESTON RD PMB 186
WESTON FL
33326
US

V. Phone/Fax

Practice location:
  • Phone: 954-577-0008
  • Fax: 954-577-0339
Mailing address:
  • Phone: 954-577-0008
  • Fax: 954-577-0339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT1542
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberARNP1838792
License Number StateFL

VIII. Authorized Official

Name: MS. TERESA MARIE BOLAND
Title or Position: OWNER
Credential: ARNP LMFT PHDC
Phone: 954-577-0008