Provider Demographics
NPI:1902670847
Name:BEHAVIORZOID LLC
Entity Type:Organization
Organization Name:BEHAVIORZOID LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:D
Authorized Official - Last Name:WISDOM
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:360-470-2183
Mailing Address - Street 1:98-501 KOAUKA LOOP APT A305
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5827
Mailing Address - Country:US
Mailing Address - Phone:360-470-2183
Mailing Address - Fax:866-635-1509
Practice Address - Street 1:970 N KALAHEO AVE STE A212
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1857
Practice Address - Country:US
Practice Address - Phone:360-470-2183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty