Provider Demographics
NPI:1467273334
Name:MAUNA PSYCHOLOGY LLC
Entity type:Organization
Organization Name:MAUNA PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVIS
Authorized Official - Middle Name:KEALANOHEA
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-609-8847
Mailing Address - Street 1:3325 N UNIVERSITY AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-7412
Mailing Address - Country:US
Mailing Address - Phone:801-609-8847
Mailing Address - Fax:
Practice Address - Street 1:3325 N UNIVERSITY AVE STE 300
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-7412
Practice Address - Country:US
Practice Address - Phone:801-609-8847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty