Provider Demographics
NPI:1659392744
Name:MELISSA LEE BELANGER PSYD INC
Entity Type:Organization
Organization Name:MELISSA LEE BELANGER PSYD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BELANGER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-247-7900
Mailing Address - Street 1:PO BOX 1451
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1451
Mailing Address - Country:US
Mailing Address - Phone:808-247-7900
Mailing Address - Fax:808-254-4526
Practice Address - Street 1:45-955 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE 306
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3222
Practice Address - Country:US
Practice Address - Phone:808-247-7900
Practice Address - Fax:808-254-4526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-753261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI55627701Medicaid
HI55627701Medicaid
HI55534Medicare ID - Type Unspecified