Healthcare Provider Details

I. General information

NPI: 1922816172
Provider Name (Legal Business Name): HAWAII BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 WALKER AVE
WAHIAWA HI
96786-1814
US

IV. Provider business mailing address

70 S KAMEHAMEHA HWY
WAHIAWA HI
96786-1856
US

V. Phone/Fax

Practice location:
  • Phone: 808-452-4782
  • Fax: 808-490-0370
Mailing address:
  • Phone: 808-452-4782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BRIAN WHITE
Title or Position: PROGRAM DIRECTOR
Credential: MSCP
Phone: 808-621-8341