Provider Demographics
NPI:1093428682
Name:BEACH, LIANNA AILI
Entity Type:Individual
Prefix:
First Name:LIANNA
Middle Name:AILI
Last Name:BEACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 RICHARD LN UNIT 0-I
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-4567
Mailing Address - Country:US
Mailing Address - Phone:425-777-1121
Mailing Address - Fax:
Practice Address - Street 1:99-1410 HALAWA HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3115
Practice Address - Country:US
Practice Address - Phone:808-681-2718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-22-248927106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician