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General NPI Number Information
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NPI Number | 1366800161
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Entity Type | Organization
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Legal Business Name | PHAITE BEHAVIORAL HEALTH CARE SERVICES
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Dates
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Enumeration Date | 02/08/2016
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Last Update Date | 07/15/2019
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Provider Practice Location Address
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Address Line | 92 ARGONAUT STE 170
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City | ALISO VIEJO
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State | CA
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Zip | 92656-4130
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Country | US
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Telephone | 949-463-8381
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Fax |
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Provider Business Mailing Address
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Address Line | 18 PIARA ST
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City | RANCHO MISSION VIEJO
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State | CA
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Zip | 92694-1821
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Country | US
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Telephone | 949-463-8381
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. BENJAMIN KAAINOA KANEAIAKALA
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Credential | MBA, LAADC
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Telephone | 949-463-8381
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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