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General NPI Number Information
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NPI Number | 1487479069
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Entity Type | Organization
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Legal Business Name | MEN HEAL
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 1075 MAKAWAO AVE UNIT 1841
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City | MAKAWAO
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State | HI
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Zip | 96768-3078
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Country | US
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Telephone | 808-283-3016
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1841
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City | MAKAWAO
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State | HI
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Zip | 96768-1841
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Country | US
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Telephone | 808-283-3016
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Fax |
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Authorized Official
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Title or Position | FOUNDER/ CEO
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Name | EMAN'ON FEARLESS WANDERER
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Credential |
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Telephone | 808-283-3016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101200000X
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Taxonomy Name | Drama Therapist
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 225600000X
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Taxonomy Name | Dance Therapist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 225A00000X
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Taxonomy Name | Music Therapist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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