Healthcare Provider Details

I. General information

NPI: 1184139156
Provider Name (Legal Business Name): RISING BEHAVIORAL HEALTH CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41-038 WAILEA ST STE C
WAIMANALO HI
96795-1671
US

IV. Provider business mailing address

41-038 WAILEA ST STE C
WAIMANALO HI
96795-1671
US

V. Phone/Fax

Practice location:
  • Phone: 808-518-4976
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAITLYN C STAFFORD
Title or Position: LCSW
Credential:
Phone: 808-518-4976