Provider Demographics
NPI:1639946601
Name:WEYMOUTH, KNOX RUDER HARRIS
Entity Type:Individual
Prefix:
First Name:KNOX
Middle Name:RUDER HARRIS
Last Name:WEYMOUTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ABA CLASSROOM 40 KUPUOHI ST. #206, LAHAINA, HI, 96761
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-9999
Mailing Address - Country:US
Mailing Address - Phone:808-446-4561
Mailing Address - Fax:
Practice Address - Street 1:ABA CLASSROOM 40 KUPUOHI ST. #206, LAHAINA, HI, 96761
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-9999
Practice Address - Country:US
Practice Address - Phone:808-446-4561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIBACB1018321106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician