Provider Demographics
NPI:1891725974
Name:ELTING, DIRK TAYLOR (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIRK
Middle Name:TAYLOR
Last Name:ELTING
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 1:45-629 KULUKEOE PL
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3504
Mailing Address - Country:US
Mailing Address - Phone:808-236-3222
Mailing Address - Fax:
Practice Address - Street 1:46-001 KAMEHAMEHA HWY STE 409
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3749
Practice Address - Country:US
Practice Address - Phone:808-236-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1178-03P101YA0400X
HIPSY-674103T00000X, 103TA0400X, 103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI56429601Medicaid
HI22711-6OtherTRICARE PIN
HI22711-6OtherHMSA PIN