Provider Demographics
NPI:1548635634
Name:MAUI RECOVERY LLC
Entity type:Organization
Organization Name:MAUI RECOVERY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SERLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-385-1574
Mailing Address - Street 1:PO BOX 11063
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-1063
Mailing Address - Country:US
Mailing Address - Phone:808-385-1574
Mailing Address - Fax:
Practice Address - Street 1:1819 S KIHEI RD
Practice Address - Street 2:STE D110
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7941
Practice Address - Country:US
Practice Address - Phone:800-919-2066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT 239106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty