Provider Demographics
NPI:1477145233
Name:PRISM BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:PRISM BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:RAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-301-6144
Mailing Address - Street 1:65 WAIAPO ST
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7356
Mailing Address - Country:US
Mailing Address - Phone:773-301-6144
Mailing Address - Fax:
Practice Address - Street 1:65 WAIAPO ST
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7356
Practice Address - Country:US
Practice Address - Phone:773-301-6144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAUSER CONSULTING SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health