Provider Demographics
NPI:1952166225
Name:EMPOWERED PATHWAYS MAUI, LLC
Entity Type:Organization
Organization Name:EMPOWERED PATHWAYS MAUI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:FANNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-419-8105
Mailing Address - Street 1:844 W KAENA PL
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-9620
Mailing Address - Country:US
Mailing Address - Phone:808-419-8105
Mailing Address - Fax:
Practice Address - Street 1:844 W KAENA PL
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-9620
Practice Address - Country:US
Practice Address - Phone:808-419-8105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional