Healthcare Provider Details

I. General information

NPI: 1942560842
Provider Name (Legal Business Name): RENEE L WETZEL LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 WAIANUENUE AVE STE 202
HILO HI
96720-2474
US

IV. Provider business mailing address

PO BOX 201
HONOMU HI
96728-0201
US

V. Phone/Fax

Practice location:
  • Phone: 808-935-4412
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC-466
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: