Provider Demographics
NPI:1285897306
Name:RIDER, JULIE ANNE (MA, MFT)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANNE
Last Name:RIDER
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4345 KUKE ST
Mailing Address - Street 2:
Mailing Address - City:KILAUEA
Mailing Address - State:HI
Mailing Address - Zip Code:96754-5310
Mailing Address - Country:US
Mailing Address - Phone:808-828-1161
Mailing Address - Fax:808-826-7437
Practice Address - Street 1:5-5161 KUHIO HWY SUITE E 202
Practice Address - Street 2:
Practice Address - City:HANALEI
Practice Address - State:HI
Practice Address - Zip Code:96714
Practice Address - Country:US
Practice Address - Phone:808-826-7433
Practice Address - Fax:808-826-7437
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI170106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist