Healthcare Provider Details

I. General information

NPI: 1265134563
Provider Name (Legal Business Name): VITALITY ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 N BERETANIA ST APT 1406
HONOLULU HI
96817-4757
US

IV. Provider business mailing address

60 N BERETANIA ST APT 1406
HONOLULU HI
96817-4757
US

V. Phone/Fax

Practice location:
  • Phone: 801-810-8346
  • Fax:
Mailing address:
  • Phone: 801-810-8346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: RACHEL LYNN BOEHMERT
Title or Position: BCBA
Credential:
Phone: 801-810-8346