=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699535518
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SLAY THERAPY & CONSULTING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2024
-----------------------------------------------------
Last Update Date | 03/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 N VINEYARD BLVD STE A325 #1106
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-463-7410
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 N VINEYARD BLVD STE A325 #1106
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-463-7410
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST
-----------------------------------------------------
Name | TAMARA D SLAY
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 808-463-7410
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------