Provider Demographics
NPI:1164834321
Name:LELAH, REUBEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:REUBEN
Middle Name:
Last Name:LELAH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73-4340 HUEHUE ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-8695
Mailing Address - Country:US
Mailing Address - Phone:808-325-1111
Mailing Address - Fax:808-325-1110
Practice Address - Street 1:73-4340 HUEHUE ST
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-8695
Practice Address - Country:US
Practice Address - Phone:808-325-1111
Practice Address - Fax:808-325-1110
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY560103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical