=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144466509
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EARL K. LAU M.A., M.F.T.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2009
-----------------------------------------------------
Last Update Date | 08/13/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 319 N CANE ST STE A
-----------------------------------------------------
City | WAHIAWA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96786-2130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-391-2289
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 46-401 HAIKU RD
-----------------------------------------------------
City | KANEOHE
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96744-3558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-391-2289
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 204
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------