Provider Demographics
NPI:1457724031
Name:TRACY M TANIGUCHI PSY D LLC
Entity Type:Organization
Organization Name:TRACY M TANIGUCHI PSY D LLC
Other - Org Name:TRACY M.T. WATANABE, PSY.D.,LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:MT
Authorized Official - Last Name:YAMASAKI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-227-7682
Mailing Address - Street 1:688 KINOOLE ST
Mailing Address - Street 2:SUITE # 206
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3877
Mailing Address - Country:US
Mailing Address - Phone:808-227-7682
Mailing Address - Fax:877-795-7918
Practice Address - Street 1:688 KINOOLE ST
Practice Address - Street 2:SUITE # 206
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3877
Practice Address - Country:US
Practice Address - Phone:808-227-7682
Practice Address - Fax:877-795-7918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1320103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1013275205OtherNPI TYPE 1