Provider Demographics
NPI:1033652029
Name:DOSLAND, MAX I (B A IN PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:
Last Name:DOSLAND
Suffix:I
Gender:M
Credentials:B A IN PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 DOOR OF FAITH RD
Mailing Address - Street 2:
Mailing Address - City:HAIKU
Mailing Address - State:HI
Mailing Address - Zip Code:96708-5705
Mailing Address - Country:US
Mailing Address - Phone:808-283-9904
Mailing Address - Fax:
Practice Address - Street 1:305 DOOR OF FAITH RD
Practice Address - Street 2:
Practice Address - City:HAIKU
Practice Address - State:HI
Practice Address - Zip Code:96708-5705
Practice Address - Country:US
Practice Address - Phone:808-283-9904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management