Healthcare Provider Details

I. General information

NPI: 1588162242
Provider Name (Legal Business Name): COMPREHENSIVE AUTISM SPECTRUM THERAPIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18-4427 MAUNA LOA DR
MOUNTAIN VIEW HI
96771-9677
US

IV. Provider business mailing address

PO BOX 612
MOUNTAIN VIEW HI
96771-0612
US

V. Phone/Fax

Practice location:
  • Phone: 808-726-5591
  • Fax:
Mailing address:
  • Phone: 808-726-5591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA-210
License Number StateHI

VIII. Authorized Official

Name: DR. VALERIE NEEDHAM
Title or Position: PRESIDENT
Credential: PSYD, BCBA, LBA
Phone: 808-726-5591