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General NPI Number Information
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NPI Number | 1497459648
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Entity Type | Individual
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Provider Name | CHRISTINE JARVIS BEHAVIOR TECHNICIAN
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Gender | Female
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Dates
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Enumeration Date | 03/29/2023
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Last Update Date | 03/29/2023
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Provider Practice Location Address
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Address Line | 7002 HAWAII KAI DR APT 1911
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City | HONOLULU
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State | HI
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Zip | 96825-4209
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Country | US
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Telephone | 808-386-7122
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Fax |
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Provider Business Mailing Address
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Address Line | 1020 KAKALA ST APT 1505
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City | KAPOLEI
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State | HI
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Zip | 96707-4546
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Country | US
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Telephone | 860-462-6884
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 23-261893
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License Number State | HI
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