Healthcare Provider Details

I. General information

NPI: 1245488063
Provider Name (Legal Business Name): GARY STEVEN REPLOGLE M.ED, CSAC, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 WAIANUENUE AVE SUITE 107
HILO HI
96720-2418
US

IV. Provider business mailing address

PO BOX 55
HONOMU HI
96728-0055
US

V. Phone/Fax

Practice location:
  • Phone: 808-217-7979
  • Fax: 808-217-7979
Mailing address:
  • Phone: 808-963-6106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: