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General NPI Number Information
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NPI Number | 1235639154
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Entity Type | Organization
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Legal Business Name | MAUI BEHAVIORAL HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 02/16/2018
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Provider Practice Location Address
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Address Line | 270 HOOKAHI ST STE 212
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City | WAILUKU
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State | HI
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Zip | 96793-1466
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Country | US
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Telephone | 808-280-4842
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 337
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City | KIHEI
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State | HI
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Zip | 96753-0337
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Country | US
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Telephone | 808-280-4842
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Fax | 855-413-0922
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT DUDLEY LANSER JR.
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Credential | LCSW
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Telephone | 808-280-4842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3066
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License Number State | HI
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