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General NPI Number Information
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NPI Number | 1518341361
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Entity Type | Organization
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Legal Business Name | PACIFIC PSYCHOLOGY PARTNERS, INC.
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Dates
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Enumeration Date | 07/11/2015
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Last Update Date | 07/11/2015
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Provider Practice Location Address
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Address Line | 2975 HALEKO RD STE 307
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City | LIHUE
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State | HI
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Zip | 96766-1366
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Country | US
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Telephone | 808-332-7190
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 321
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City | ANAHOLA
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State | HI
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Zip | 96703-0321
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Country | US
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Telephone | 808-332-7190
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. ALEXANXDER JAY BIVENS
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Credential | PH.D.
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Telephone | 808-332-7190
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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 | 702
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 743
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License Number State | HI
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