Provider Demographics
NPI:1144729989
Name:BY THE WAVES, LLC
Entity type:Organization
Organization Name:BY THE WAVES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELBA
Authorized Official - Middle Name:C
Authorized Official - Last Name:STETZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCN, BCB
Authorized Official - Phone:808-347-4626
Mailing Address - Street 1:97 AIKAHI LOOP
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1674
Mailing Address - Country:US
Mailing Address - Phone:808-347-4626
Mailing Address - Fax:
Practice Address - Street 1:97 AIKAHI LOOP
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1674
Practice Address - Country:US
Practice Address - Phone:808-347-4626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-I103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty