| The Ecotherapy Place Llc | |
|
18320 Persimmon Ridge Rd Alva FL 33920-2037 | |
| (239) 895-6954 | |
| Not Available |
| Full Name | The Ecotherapy Place Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 18320 Persimmon Ridge Rd, Alva, Florida |
| Authorized Official Name and Position | Cristiane Fernandes (CLINICIAN) |
| Authorized Official Contact | 2398956954 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Ecotherapy Place Llc Po Box 2037 Alva FL 33920-2037 Ph: (239) 895-6954 | The Ecotherapy Place Llc 18320 Persimmon Ridge Rd Alva FL 33920-2037 Ph: (239) 895-6954 |
| NPI Number | 1992448161 |
|---|---|
| Provider Enumeration Date | 04/15/2022 |
| Last Update Date | 10/13/2022 |
| Certification Date | 10/13/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992448161 | NPI | - | NPPES |
| 111229900 | Medicaid | FL | |
| 114247300 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
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