Healthcare Provider Details

I. General information

NPI: 1013408913
Provider Name (Legal Business Name): RACHEL LEIGH LEWIS MASTERS OF SCIENCES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 11/05/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15-1724 27TH AVE
KEAAU HI
96749
US

IV. Provider business mailing address

15-2689 MANALO ST
PAHOA HI
96778-9002
US

V. Phone/Fax

Practice location:
  • Phone: 808-431-3800
  • Fax:
Mailing address:
  • Phone: 808-431-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: