Healthcare Provider Details

I. General information

NPI: 1932688165
Provider Name (Legal Business Name): BEHAVIOR ANALYSIS AND FAMILY THERAPY CENTER OF HAWAII
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NORTH VINEYARD BLVD SUITE B 270
HONOLULU HI
96817
US

IV. Provider business mailing address

PO BOX 17803
HONOLULU HI
96817
US

V. Phone/Fax

Practice location:
  • Phone: 808-215-7755
  • Fax: 808-744-3639
Mailing address:
  • Phone: 808-215-7755
  • Fax: 808-744-3639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA-105
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT-426
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: ANNETTE CHEW
Title or Position: CLINICAL DIRECTOR
Credential: MFT, BCBS, LBA
Phone: 808-454-3146