Provider Demographics
NPI:1003268012
Name:WALLACE R. SHRINSKI, MFT
Entity Type:Organization
Organization Name:WALLACE R. SHRINSKI, MFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHRINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:808-987-7306
Mailing Address - Street 1:PO BOX 2264
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-2264
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75-127 LUNAPULE RD
Practice Address - Street 2:15B
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2119
Practice Address - Country:US
Practice Address - Phone:808-987-7306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI230251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health