Provider Demographics
NPI:1861147357
Name:BEHAVIORAL HEALTH & FAMILY MANAGEMENT
Entity type:Organization
Organization Name:BEHAVIORAL HEALTH & FAMILY MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEESHA-ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-358-2991
Mailing Address - Street 1:47-241 HUI IWA ST APT C
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-4344
Mailing Address - Country:US
Mailing Address - Phone:808-358-2991
Mailing Address - Fax:
Practice Address - Street 1:47-653 KAMEHAMEHA HWY STE 205
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-4965
Practice Address - Country:US
Practice Address - Phone:808-358-2991
Practice Address - Fax:808-239-9763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-14
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty