Provider Demographics
NPI:1245698885
Name:STEVEN R. TAKETA, PSY.D., LLC
Entity type:Organization
Organization Name:STEVEN R. TAKETA, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:TAKETA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-782-3551
Mailing Address - Street 1:PO BOX 4613
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-8613
Mailing Address - Country:US
Mailing Address - Phone:808-782-3551
Mailing Address - Fax:
Practice Address - Street 1:99-128 AIEA HEIGHTS DR STE 109
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3916
Practice Address - Country:US
Practice Address - Phone:808-782-3551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY - 1333251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health