Healthcare Provider Details

I. General information

NPI: 1518341361
Provider Name (Legal Business Name): PACIFIC PSYCHOLOGY PARTNERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2015
Last Update Date: 07/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 HALEKO RD STE 307
LIHUE HI
96766-1366
US

IV. Provider business mailing address

PO BOX 321
ANAHOLA HI
96703-0321
US

V. Phone/Fax

Practice location:
  • Phone: 808-332-7190
  • Fax:
Mailing address:
  • Phone: 808-332-7190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number702
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number743
License Number StateHI

VIII. Authorized Official

Name: DR. ALEXANXDER JAY BIVENS
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 808-332-7190