Provider Demographics
NPI:1881279156
Name:KINIKINI, BROOKE LEE (BCABA)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:LEE
Last Name:KINIKINI
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:LEE
Other - Last Name:HINTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:S KIHEI RD.
Mailing Address - Street 2:SUITE 0735
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-5220
Mailing Address - Country:US
Mailing Address - Phone:808-280-7524
Mailing Address - Fax:
Practice Address - Street 1:2831 ELDORADO PKWY STE 106
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-7438
Practice Address - Country:US
Practice Address - Phone:214-778-1153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI0-20-11518106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0-20-11518OtherBCABA
HIBCBA475882OtherBACB