=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356564777
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAHY BAILEY, PH.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4-1435 KUHIO HWY SUITE 206
-----------------------------------------------------
City | KAPAA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96746-1745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-822-2447
-----------------------------------------------------
Fax | 808-821-0136
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 657
-----------------------------------------------------
City | KILAUEA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96754-0657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-822-2447
-----------------------------------------------------
Fax | 808-821-0136
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT & CEO
-----------------------------------------------------
Name | DR. FAHY BAILEY
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 808-822-2447
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PSY 345
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------