1356109888 NPI number — MEADOWBROOK COUNSELING OF HAWAII

Table of content: (NPI 1356109888)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356109888 NPI number — MEADOWBROOK COUNSELING OF HAWAII

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEADOWBROOK COUNSELING OF HAWAII
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356109888
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1469 N 1200 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OREM
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84057-2449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-655-5450
Provider Business Mailing Address Fax Number:
385-225-9327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 ALA MOANA BLVD STE 7400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813-4902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-655-5450
Provider Business Practice Location Address Fax Number:
385-225-9327
Provider Enumeration Date:
03/11/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HEBBERT
Authorized Official First Name:
WHITNEY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER, PROVIDER
Authorized Official Telephone Number:
801-655-5450

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)