Provider Demographics
NPI:1275780918
Name:MRAZ, REBEKAH L
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:L
Last Name:MRAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:L
Other - Last Name:ESENWINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1467
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-1467
Mailing Address - Country:US
Mailing Address - Phone:808-934-8787
Mailing Address - Fax:808-934-8797
Practice Address - Street 1:1045 KILAUEA AVE STE A
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4291
Practice Address - Country:US
Practice Address - Phone:808-961-5166
Practice Address - Fax:808-934-0071
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT 232106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist