Provider Demographics
NPI:1396278271
Name:MAUI THERAPY LLC
Entity type:Organization
Organization Name:MAUI THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SERLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT
Authorized Official - Phone:808-661-1177
Mailing Address - Street 1:PO BOX 11063
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-1063
Mailing Address - Country:US
Mailing Address - Phone:808-661-1177
Mailing Address - Fax:808-442-8118
Practice Address - Street 1:181 LAHAINALUNA RD
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-1585
Practice Address - Country:US
Practice Address - Phone:808-661-1177
Practice Address - Fax:808-442-8118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT-239106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty