Healthcare Provider Details

I. General information

NPI: 1538239785
Provider Name (Legal Business Name): HALONA WES TANNER PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46-213 KALALI ST
KANEOHE HI
96744-4128
US

IV. Provider business mailing address

46-005 KAWA ST SUITE 304
KANEOHE HI
96744-3805
US

V. Phone/Fax

Practice location:
  • Phone: 808-282-1081
  • Fax: 808-239-9493
Mailing address:
  • Phone: 808-282-1081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-1020
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: