Provider Demographics
NPI:1740633114
Name:IMI OLA AUTISM SERVICES
Entity type:Organization
Organization Name:IMI OLA AUTISM SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TARYN
Authorized Official - Middle Name:K
Authorized Official - Last Name:AWANA-SCANLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:808-979-1824
Mailing Address - Street 1:590 FARRINGTON HWY
Mailing Address - Street 2:#524-225
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:590 FARRINGTON HWY
Practice Address - Street 2:#524-225
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2009
Practice Address - Country:US
Practice Address - Phone:808-979-1824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIBA-78251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIBA-78OtherSTATE OF HAWAII
HI1-14-17089OtherBEHAVIOR ANALYST CERTIFICATION BOARD