Provider Demographics
NPI:1912153206
Name:BOTHELL, WILLIAM
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BOTHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:
Other - Last Name:BOTHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:74-381 KEALAKEHE PKWY
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2705
Mailing Address - Country:US
Mailing Address - Phone:808-589-1829
Mailing Address - Fax:808-589-2610
Practice Address - Street 1:74-381 KEALAKEHE PKWY
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2705
Practice Address - Country:US
Practice Address - Phone:808-589-1829
Practice Address - Fax:808-589-2610
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI516104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker