Healthcare Provider Details

I. General information

NPI: 1265395685
Provider Name (Legal Business Name): LIZZIE ANNE KAMSTRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ABA CLASSROOM #206-40 KUPUOHI ST. 204
LAHAINA HI
96761
US

IV. Provider business mailing address

101 GILLESPIE DR APT 10302
FRANKLIN TN
37067-7548
US

V. Phone/Fax

Practice location:
  • Phone: 808-446-4561
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: