Healthcare Provider Details

I. General information

NPI: 1982184222
Provider Name (Legal Business Name): TYLER LEE KOLB RBT, NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 ALA MAKANI ST
KAHULUI HI
96732-3571
US

IV. Provider business mailing address

495 LIHOLIHO ST APT 107
WAILUKU HI
96793-2678
US

V. Phone/Fax

Practice location:
  • Phone: 808-204-2893
  • Fax:
Mailing address:
  • Phone: 732-814-0152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3532190
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: