Provider Demographics
NPI:1114988607
Name:T BOLAND ARNP LMFT PHDC INC
Entity Type:Organization
Organization Name:T BOLAND ARNP LMFT PHDC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BOLAND
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP LMFT PHDC
Authorized Official - Phone:954-577-0008
Mailing Address - Street 1:1112 WESTON RD
Mailing Address - Street 2:PMB 186
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326
Mailing Address - Country:US
Mailing Address - Phone:954-577-0008
Mailing Address - Fax:954-577-0339
Practice Address - Street 1:555 SW 148TH AVE
Practice Address - Street 2:STE 130
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33325
Practice Address - Country:US
Practice Address - Phone:954-577-0008
Practice Address - Fax:954-577-0339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1542106H00000X
FLARNP1838792163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Not Answered163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0344908900Medicaid
S04028Medicare UPIN
Y4622Medicare ID - Type Unspecified