Provider Demographics
NPI:1275209199
Name:BUTIHI, LOURDES AGORRA (RBT-21-179281)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:AGORRA
Last Name:BUTIHI
Suffix:
Gender:F
Credentials:RBT-21-179281
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 ALA MAKANI ST STE 200
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-3507
Mailing Address - Country:US
Mailing Address - Phone:808-244-6879
Mailing Address - Fax:
Practice Address - Street 1:427 ALA MAKANI ST STE 200
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3507
Practice Address - Country:US
Practice Address - Phone:808-244-6879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-21-179281106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician