Provider Demographics
NPI:1659442218
Name:BEARDEN, THOMAS STENNIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:STENNIS
Last Name:BEARDEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 AUPUNI ST
Mailing Address - Street 2:SUITE 1014 A-2
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4246
Mailing Address - Country:US
Mailing Address - Phone:808-935-2605
Mailing Address - Fax:808-935-2650
Practice Address - Street 1:101 AUPUNI ST
Practice Address - Street 2:SUITE 1014 A-2
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4246
Practice Address - Country:US
Practice Address - Phone:808-935-2605
Practice Address - Fax:808-935-2650
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 888103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000252676OtherHMSA PROVIDER NUMBER
HI57172001Medicaid
HI0000252676OtherHMSA PROVIDER NUMBER