Provider Demographics
NPI:1891145389
Name:SMITH, CHRIS
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:SMITH
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 1:401 PAPALOA RD APT 608
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-1431
Mailing Address - Country:US
Mailing Address - Phone:832-613-7198
Mailing Address - Fax:
Practice Address - Street 1:3-3122 KUHIO HWY
Practice Address - Street 2:A15
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1147
Practice Address - Country:US
Practice Address - Phone:832-613-7198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst