Provider Demographics
NPI:1790422509
Name:WAILEA COUNSELING & HEALING ARTS MAUI INC
Entity Type:Organization
Organization Name:WAILEA COUNSELING & HEALING ARTS MAUI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:808-280-5804
Mailing Address - Street 1:PO BOX 532698
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-2644
Mailing Address - Country:US
Mailing Address - Phone:808-280-5804
Mailing Address - Fax:833-468-0079
Practice Address - Street 1:95 E LIPOA ST STE 204
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8194
Practice Address - Country:US
Practice Address - Phone:808-280-5804
Practice Address - Fax:833-468-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-14
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty