Provider Demographics
NPI:1154650737
Name:BEHAVIOR SERVICE OF HAWAII, LLC
Entity Type:Organization
Organization Name:BEHAVIOR SERVICE OF HAWAII, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TATEKAWA
Authorized Official - Suffix:
Authorized Official - Credentials:SLP, BCBA
Authorized Official - Phone:808-778-6715
Mailing Address - Street 1:95-732 MAIAKU ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-2816
Mailing Address - Country:US
Mailing Address - Phone:808-778-6715
Mailing Address - Fax:
Practice Address - Street 1:95-732 MAIAKU ST
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-2816
Practice Address - Country:US
Practice Address - Phone:808-778-6715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1084054103K00000X
HISP 1016235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty