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General NPI Number Information
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NPI Number | 1811320377
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Entity Type | Organization
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Legal Business Name | OASIS FOR CHANGE
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Dates
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Enumeration Date | 08/19/2013
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Last Update Date | 08/19/2013
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Provider Practice Location Address
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Address Line | 970 N KALAHEO AVE STE A212
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City | KAILUA
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State | HI
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Zip | 96734-1857
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Country | US
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Telephone | 808-343-4279
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1605
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City | KAILUA
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State | HI
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Zip | 96734-8605
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Country | US
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Telephone | 808-343-4279
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARY PRESTON
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Credential | LMFT
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Telephone | 808-282-6301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 351
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License Number State | HI
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