Provider Demographics
NPI:1306689740
Name:AMANDA WEBSTER WELLNESS
Entity type:Organization
Organization Name:AMANDA WEBSTER WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:808-209-7979
Mailing Address - Street 1:PO BOX 711485
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:HI
Mailing Address - Zip Code:96771-1485
Mailing Address - Country:US
Mailing Address - Phone:808-209-7979
Mailing Address - Fax:
Practice Address - Street 1:688 KINOOLE ST STE 212
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3869
Practice Address - Country:US
Practice Address - Phone:808-209-7979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-14
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty