Provider Demographics
NPI:1285414086
Name:SELLER, PIPER SUE
Entity type:Individual
Prefix:
First Name:PIPER
Middle Name:SUE
Last Name:SELLER
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 1:1038 ULU KANU ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-8320
Mailing Address - Country:US
Mailing Address - Phone:808-385-7595
Mailing Address - Fax:
Practice Address - Street 1:1038 ULU KANU ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-8320
Practice Address - Country:US
Practice Address - Phone:808-385-7595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician