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General NPI Number Information
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NPI Number | 1316569296
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL HEALTH SERVICES OF MAUI, LLC
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Dates
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Enumeration Date | 05/13/2020
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 1787 WILI PA LOOP STE 7
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City | WAILUKU
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State | HI
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Zip | 96793-1271
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Country | US
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Telephone | 808-249-2213
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1406
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City | WAILUKU
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State | HI
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Zip | 96793-6406
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DAVID WITTENBERG
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Credential | PSYD
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Telephone | 808-281-6284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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