Provider Demographics
NPI:1104332477
Name:SOARES, TIANA
Entity type:Individual
Prefix:
First Name:TIANA
Middle Name:
Last Name:SOARES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 KANEOHE BAY DR UNIT 211212
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1727
Mailing Address - Country:US
Mailing Address - Phone:808-388-1683
Mailing Address - Fax:
Practice Address - Street 1:111 HEKILI ST STE A406
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2800
Practice Address - Country:US
Practice Address - Phone:808-489-3548
Practice Address - Fax:808-443-0708
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-15-10366106S00000X
HI1-23-69665103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician