Provider Demographics
NPI:1649227992
Name:ANSEL, MARK G (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:G
Last Name:ANSEL
Suffix:
Gender:M
Credentials:PHD, LCSW
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 1469
Mailing Address - Street 2:
Mailing Address - City:KAPAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96755-1439
Mailing Address - Country:US
Mailing Address - Phone:808-884-5300
Mailing Address - Fax:808-884-5300
Practice Address - Street 1:54-3885A AKONI PULE HIGHWAY
Practice Address - Street 2:
Practice Address - City:KAPAAU
Practice Address - State:HI
Practice Address - Zip Code:96755-1439
Practice Address - Country:US
Practice Address - Phone:808-884-5300
Practice Address - Fax:808-884-5300
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI31151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical