Provider Demographics
NPI:1952827438
Name:TAN, STACY HAUNANI (LCSW)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:HAUNANI
Last Name:TAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:HAUNANI
Other - Last Name:TERASHITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:265 OHAOHA PL
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-7709
Mailing Address - Country:US
Mailing Address - Phone:808-352-3525
Mailing Address - Fax:
Practice Address - Street 1:55 MAUI LANI PKWY
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2416
Practice Address - Country:US
Practice Address - Phone:808-243-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI37241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical