Healthcare Provider Details

I. General information

NPI: 1770294613
Provider Name (Legal Business Name): MEGAN LEIGH REVOLT BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 KALAKAUA AVE STE 701
HONOLULU HI
96815-2341
US

IV. Provider business mailing address

2155 KALAKAUA AVE STE 701
HONOLULU HI
96815-2341
US

V. Phone/Fax

Practice location:
  • Phone: 808-501-2362
  • Fax:
Mailing address:
  • Phone: 808-501-2362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2830728
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: