Healthcare Provider Details

I. General information

NPI: 1154995538
Provider Name (Legal Business Name): DEBRA VAN DE TAEYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4643E PUUWAI RD
KALAHEO HI
96741-9331
US

IV. Provider business mailing address

4643E PUUWAI RD
KALAHEO HI
96741-9331
US

V. Phone/Fax

Practice location:
  • Phone: 720-236-6418
  • Fax:
Mailing address:
  • Phone: 720-236-6418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number247
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: