Provider Demographics
NPI:1417258518
Name:SERLE, JAY L (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:L
Last Name:SERLE
Suffix:
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11063
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-1063
Mailing Address - Country:US
Mailing Address - Phone:808-661-1177
Mailing Address - Fax:
Practice Address - Street 1:181 LAHAINALUNA RD STE E
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-1585
Practice Address - Country:US
Practice Address - Phone:808-661-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-06
Last Update Date:2014-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT #239106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist