Provider Demographics
NPI:1265147938
Name:ALLEN, MICHAEL TRAVIS
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TRAVIS
Last Name:ALLEN
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 1:427 ALA MAKANI ST
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-3571
Mailing Address - Country:US
Mailing Address - Phone:808-204-2893
Mailing Address - Fax:
Practice Address - Street 1:427 ALA MAKANI ST
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3571
Practice Address - Country:US
Practice Address - Phone:808-204-2893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician