Provider Demographics
NPI: | 1619561487 |
---|---|
Name: | WHOLISTIC THERAPEUTIC SERVICES, LLC |
Entity Type: | Organization |
Organization Name: | WHOLISTIC THERAPEUTIC SERVICES, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/FOUNDER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MARTINE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LALANNE-JEAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LMFT |
Authorized Official - Phone: | 561-952-6972 |
Mailing Address - Street 1: | 1856 N NOB HILL RD # 207 |
Mailing Address - Street 2: | |
Mailing Address - City: | PLANTATION |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33322-6548 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 561-952-6972 |
Mailing Address - Fax: | 954-901-2737 |
Practice Address - Street 1: | 2130 NW 99 WAY |
Practice Address - Street 2: | |
Practice Address - City: | SUNSRISE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33322-6548 |
Practice Address - Country: | US |
Practice Address - Phone: | 561-952-6872 |
Practice Address - Fax: | 954-901-2737 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-02-23 |
Last Update Date: | 2021-02-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Single Specialty |