Provider Demographics
NPI:1952341224
Name:ADAIR-LELAND, JEAN (PHD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:ADAIR-LELAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1484 HIIKALA PLACE
Mailing Address - Street 2:#13
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5633
Mailing Address - Country:US
Mailing Address - Phone:808-384-5172
Mailing Address - Fax:
Practice Address - Street 1:4211 WAIALAE AVE
Practice Address - Street 2:STE. 206B
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5319
Practice Address - Country:US
Practice Address - Phone:808-739-6224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI220103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIE00389-6Medicaid
HIR17891Medicare UPIN
HIE00389-6Medicaid