Healthcare Provider Details

I. General information

NPI: 1154650737
Provider Name (Legal Business Name): BEHAVIOR SERVICE OF HAWAII, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-732 MAIAKU ST
MILILANI HI
96789-2816
US

IV. Provider business mailing address

95-732 MAIAKU ST
MILILANI HI
96789-2816
US

V. Phone/Fax

Practice location:
  • Phone: 808-778-6715
  • Fax:
Mailing address:
  • Phone: 808-778-6715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1084054
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP 1016
License Number StateHI

VIII. Authorized Official

Name: BRIANNA MARIE TATEKAWA
Title or Position: OWNER
Credential: SLP, BCBA
Phone: 808-778-6715