Provider Demographics
NPI:1164901344
Name:OHANA MUA BEHAVIORAL THERAPY
Entity Type:Organization
Organization Name:OHANA MUA BEHAVIORAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANI
Authorized Official - Middle Name:G
Authorized Official - Last Name:NIKOLOVA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-762-9785
Mailing Address - Street 1:590 FARRINGTON HWY UNIT 524-226
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:590 FARRINGTON HWY UNIT 524-226
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2009
Practice Address - Country:US
Practice Address - Phone:808-762-9785
Practice Address - Fax:808-441-7729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI185103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty