Provider Demographics
NPI:1508232596
Name:MICHAELS, JEREMIAH (MA)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:
Last Name:MICHAELS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2366 PUU MALA PL
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7146
Mailing Address - Country:US
Mailing Address - Phone:808-269-2357
Mailing Address - Fax:
Practice Address - Street 1:2366 PUU MALA PL
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7146
Practice Address - Country:US
Practice Address - Phone:808-269-2357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)