Healthcare Provider Details

I. General information

NPI: 1952432635
Provider Name (Legal Business Name): ALOHA BEHAVIORAL CONSULTANTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 N HARRISVILLE ROAD
HARRISVILLE UT
84404-2580
US

IV. Provider business mailing address

811 N HARRISVILLE RD
HARRISVILLE UT
84404-3537
US

V. Phone/Fax

Practice location:
  • Phone: 801-399-1818
  • Fax: 801-782-8412
Mailing address:
  • Phone: 801-399-1818
  • Fax: 801-782-8412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. M SHAWN PALAU
Title or Position: CLINICAL DIRECTOR
Credential: LCSW
Phone: 801-399-1818