Healthcare Provider Details

I. General information

NPI: 1942266739
Provider Name (Legal Business Name): JOHN LOUIS MYHRE PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86-260 FARRINGTON HWY
WAIANAE HI
96792-3128
US

IV. Provider business mailing address

91-1110 LAAULU ST #16-B
EWA BEACH HI
96706-4302
US

V. Phone/Fax

Practice location:
  • Phone: 808-696-1469
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPSY770
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: