Healthcare Provider Details

I. General information

NPI: 1376991471
Provider Name (Legal Business Name): PACIFIC PSYCHOLOGY SERVICES CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 KAPIOLANI BLVD SUITE 621
HONOLULU HI
96814-4402
US

IV. Provider business mailing address

1441 KAPIOLANI BLVD SUITE 621
HONOLULU HI
96814-4402
US

V. Phone/Fax

Practice location:
  • Phone: 808-294-3595
  • Fax: 866-270-8635
Mailing address:
  • Phone: 808-294-3595
  • Fax: 866-270-8635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberPSY 697
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberPSY 697
License Number StateHI

VIII. Authorized Official

Name: DR. COLIN BEVERIDGE DENNEY
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 808-294-3595